Basic Information
| Provider Information | |||||||||
| NPI: | 1447390752 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | KENT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1595 SOQUEL DR STE 330 | ||||||||
| Address2: | |||||||||
| City: | SANTA CRUZ | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950651722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314657761 | ||||||||
| FaxNumber: | 8314751156 | ||||||||
| Practice Location | |||||||||
| Address1: | 1820 41ST AVE. STE D | ||||||||
| Address2: | |||||||||
| City: | CAPITOLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314763000 | ||||||||
| FaxNumber: | 8314769009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | 208000000X | G15557 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | G15557 | 01 | CA | MEDICAL LICENSE | OTHER |