Active NPI
Kevin David Haley, P.A.
- Physician Assistant
- Irvine, CA
National Provider Identifier
1730235383
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA12297
- Practice address
- 5405 Alton Pkwy
Suite 5-a-300
Irvine, CA 92604-3717 - Phone
- (949) 654-4444
- NPI assigned
- Jan 26, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA12297 | CA | Primary |
Addresses
Primary practice location
5405 Alton Pkwy
Suite 5-a-300
Irvine, CA 92604-3717
Mailing address
5405 Alton Pkwy
Suite 5-a-300
Irvine, CA 92604-3717
Phone (949) 654-4444
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA12297 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA12297 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1338940800000",
"number": "1730235383",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5405 ALTON PKWY",
"address_2": "SUITE 5-A-300",
"city": "IRVINE",
"state": "CA",
"postal_code": "926043717",
"telephone_number": "949-654-4444"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5405 ALTON PKWY",
"address_2": "SUITE 5-A-300",
"city": "IRVINE",
"state": "CA",
"postal_code": "926043717",
"telephone_number": "949-654-4444"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HALEY",
"first_name": "KEVIN",
"middle_name": "DAVID",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-26",
"last_updated": "2012-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA12297",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PA12297",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Irvine, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.