Kevin Christopher Dewalt, M.D.

Primary specialty

General Acute Care HospitalTaxonomy code 282N00000X

License

A92755 Issued in CA

Practice address

108 Granada Dr
Mountain View, CA 94043-4556

Phone

(650) 796-2113

NPI assigned

Aug 6, 2007

Sex

Male

Sole proprietor

Yes

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

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• County of Los Angeles

  dba County of Los Angeles Harbor UCLA Medical Center

  • General Acute Care Hospital
  • Torrance, CA
  • NPI 1851363188
  Medicare reassignment NPD
• County of Los Angeles

  • Clinic/Center
  • Los Angeles, CA
  • NPI 1295407401
  NPD

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

{
    "created_epoch": "1186358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1186358400000",
    "number": "1790976637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 GRANADA DR",
            "city": "MOUNTAIN VIEW",
            "state": "CA",
            "postal_code": "940434556",
            "telephone_number": "650-796-2113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 GRANADA DR",
            "city": "MOUNTAIN VIEW",
            "state": "CA",
            "postal_code": "940434556",
            "telephone_number": "650-796-2113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEWALT",
        "first_name": "KEVIN",
        "middle_name": "CHRISTOPHER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-08-06",
        "last_updated": "2007-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "CA",
            "license": "A92755",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Derick Wang DMD PC
• Casey Jay Derr, D.C.
• Erika Deshmukh, MS, RD
• Devally Transit LLC
• Estella Devine, LCSW
• Nirmaljit Kaur Dhami, M.D.
• Randeep Dhillon, DDS
• DHP Group, Inc
• Angel Ignacio Diaz Jimenez
• Nallely Elizabeth Diaz Jimenez

• General Acute Care Hospital in Mountain View, CA
• Providers in Mountain View, CA by specialty
• General Acute Care Hospital in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2007; 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.

Verify at the official NPI Registry.