Basic Information
| Provider Information | |||||||||
| NPI: | 1275598831 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HILTON | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | RICHARD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1235 W VINE ST | ||||||||
| Address2: | SUITE 22 | ||||||||
| City: | LODI | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952405144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093348520 | ||||||||
| FaxNumber: | 2093342109 | ||||||||
| Practice Location | |||||||||
| Address1: | 1235 W VINE ST | ||||||||
| Address2: | SUITE 22 | ||||||||
| City: | LODI | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952405144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093348520 | ||||||||
| FaxNumber: | 2093342109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2006 | ||||||||
| LastUpdateDate: | 05/19/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | G079838 | CA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.