Kevin Mark, ATC, EMT-B

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

1100 N Grand Ave
Walnut, CA 91789-1399

Phone

(909) 274-6555

NPI assigned

Mar 12, 2018

Last updated

Feb 13, 2020By 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 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1520812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581552000000",
    "number": "1518460948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9610 LONGDEN AVE",
            "city": "TEMPLE CITY",
            "state": "CA",
            "postal_code": "917801447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 N GRAND AVE",
            "city": "WALNUT",
            "state": "CA",
            "postal_code": "917891399",
            "telephone_number": "909-274-6555"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9610 Longden Ave",
            "address_purpose": "LOCATION",
            "city": "Temple City",
            "state": "CA",
            "postal_code": "917801447",
            "country_code": "US",
            "telephone_number": "626-616-8856",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARK",
        "first_name": "KEVIN",
        "credential": "ATC, EMT-B",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-12",
        "last_updated": "2020-02-13",
        "certification_date": "2020-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "146N00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medical Technician, Basic",
            "state": "CA",
            "license": "E115899",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Walnut, CA
• Providers in Walnut, CA by specialty
• Athletic Trainer in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2020; 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.