Provider Demographics
NPI:1679584486
Name:KAVANAUGH, ARTHUR (MD)
Entity type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:
Last Name:KAVANAUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2957 FRIED AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-2232
Mailing Address - Country:US
Mailing Address - Phone:858-657-7044
Mailing Address - Fax:858-657-7045
Practice Address - Street 1:9350 CAMPUS POINT DR
Practice Address - Street 2:MAIL CODE 0997
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1300
Practice Address - Country:US
Practice Address - Phone:858-657-7044
Practice Address - Fax:858-657-7045
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50307207K00000X, 207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C503070Medicaid
CA00C503070Medicaid
CAC17740Medicare UPIN