Provider Demographics
NPI:1730227430
Name:RUHGE, KEVIN M (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:M
Last Name:RUHGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 ALESSANDRO PL STE 300
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-4001
Mailing Address - Country:US
Mailing Address - Phone:626-397-9095
Mailing Address - Fax:626-397-9099
Practice Address - Street 1:50 ALESSANDRO PL STE 300
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-4001
Practice Address - Country:US
Practice Address - Phone:626-397-9095
Practice Address - Fax:626-397-9099
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA65129208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A651290Medicaid
CA00A651290Medicaid
CAP00118753Medicare ID - Type UnspecifiedRAILROAD MEDICARE