Provider Demographics
NPI:1487617064
Name:LETZ, KEVIN LEE (DNP, NP)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LEE
Last Name:LETZ
Suffix:
Gender:M
Credentials:DNP, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PASTEUR DR
Mailing Address - Street 2:SUMC - PEDS PHYSICIAN BILLING MC:5530
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94305-2200
Mailing Address - Country:US
Mailing Address - Phone:650-498-7391
Mailing Address - Fax:650-725-7888
Practice Address - Street 1:300 PASTEUR DR
Practice Address - Street 2:SUMC - PEDS PHYSICIAN BILLING MC:5530
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94305-2200
Practice Address - Country:US
Practice Address - Phone:650-498-7391
Practice Address - Fax:650-725-7888
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP17933363L00000X
IN71000749A363LF0000X
AZAP3102363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
11059766OtherCAQH
500029255OtherRAILROAD MEDICARE
IN200229520Medicaid
IN200229520Medicaid
188810Medicare ID - Type Unspecified