Individual provider Active NPI

Kevin T Holleman, D.O.

  • Psychiatry Physician
  • San Diego, CA
National Provider Identifier
1639475437
Registry record updated Apr 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
20A12213 Issued in CA
Practice address
8775 Aero Dr Ste 238
San Diego, CA 92123-1756
Phone
(619) 930-9524
Fax
(954) 838-5438
NPI assigned
Jan 27, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 20A12213 CA Primary

Addresses

Primary practice location

8775 Aero Dr Ste 238
San Diego, CA 92123-1756

Mailing address

3812 Park Blvd Unit 509
San Diego, CA 92103-0909
Phone (619) 788-9008

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190109003358 CA Practitioner - PsychiatryPractitioner - Geriatric Psychiatry 5193061240 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
PsychiatryAlso: Geriatric Psychiatry
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Southern California Psychology Centers ApcGroup PAC ID 6406170653, 23 clinicians

Practice addresses (Care Compare)

8775 Aero Dr
Suite 238
San Diego, CA 92123-1756
Phone (619) 930-9524

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
12213CAMDSpecialist
20A12213CAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Psychology Centers, Apc CurrentSince Nov 6, 2018 Accepting new patients

Locations

8775 Aero Dr
Ste 238
San Diego, CA 92123
Phone (619) 930-9524

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1296086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745625600000",
    "number": "1639475437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3812 PARK BLVD UNIT 509",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921030909",
            "telephone_number": "619-788-9008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8775 AERO DR STE 238",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921231756",
            "telephone_number": "619-930-9524",
            "fax_number": "954-838-5438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLEMAN",
        "first_name": "KEVIN",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-01-27",
        "last_updated": "2025-04-26",
        "certification_date": "2025-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "20A12213",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.