Provider Demographics
NPI:1760444731
Name:O'BRIEN, KEVIN CHARLES (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:CHARLES
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2801 ATLANTIC AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1701
Mailing Address - Country:US
Mailing Address - Phone:562-933-8743
Mailing Address - Fax:562-933-8764
Practice Address - Street 1:2801 ATLANTIC AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1701
Practice Address - Country:US
Practice Address - Phone:562-933-8743
Practice Address - Fax:562-933-8764
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82855208000000X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A828550Medicaid
A82855OtherBLUE CROSS
00A82855OtherBLUE SHIELD