Provider Demographics
NPI:1437020351
Name:KEVIN G WALDRON MD FAANS APC
Entity type:Organization
Organization Name:KEVIN G WALDRON MD FAANS APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:WALDRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-328-9240
Mailing Address - Street 1:24022 CALLE DE LA PLATA STE 415
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3630
Mailing Address - Country:US
Mailing Address - Phone:934-328-9240
Mailing Address - Fax:934-328-9280
Practice Address - Street 1:24022 CALLE DE LA PLATA STE 415
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3630
Practice Address - Country:US
Practice Address - Phone:934-328-9240
Practice Address - Fax:934-328-9280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11498294OtherCAQH
CAC147602OtherCALIFORNIAMEDLICENSE