Basic Information
| Provider Information | |||||||||
| NPI: | 1073999660 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEVIN | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14320 PALM DR | ||||||||
| Address2: | |||||||||
| City: | DESERT HOT SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922406874 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607736767 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 14320 PALM DR | ||||||||
| Address2: | |||||||||
| City: | DESERT HOT SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922406874 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607736767 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2015 | ||||||||
| LastUpdateDate: | 01/27/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 32363 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.