Kevin Bouldin

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

2130 E 4TH St
Santa Ana, CA 92705-3818

Phone

(714) 543-5437

Fax

(999) 999-9999

NPI assigned

Nov 30, 2023

Last updated

Aug 26, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Olive Crest

  • Mental Illness Community Based Residential Treatment Facility
  • Perris, CA
  • NPI 1285288316
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1701302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787702400000",
    "number": "1497521488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15160 TEAKWOOD ST",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925307321",
            "telephone_number": "951-279-3222",
            "fax_number": "951-279-5222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2130 E 4TH ST",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927053818",
            "telephone_number": "714-543-5437",
            "fax_number": "999-999-9999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULDIN",
        "first_name": "KEVIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-11-30",
        "last_updated": "2026-08-26",
        "certification_date": "2026-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Botros & Nguyen Dental Corp (Crystal Smile Dental)
• Sylvia Botros
• Janice Botzbach, MS, BCBA
• Angela Rose Bouder
• Kellie Bougard -Jordan
• Skylar Rae Boulton
• Brittany Dee Bounds, MSW
• James Boury, RBT
• Kimberly D Bova, PHD
• Teresa Bowdry

• Student in an Organized Health Care Education/Training Program in Santa Ana, CA
• Providers in Santa Ana, CA by specialty
• Student in an Organized Health Care Education/Training Program in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.