DR. KEVIN WAYNE BRODER (NPI# 1205885902) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205885902 |
| Entity Type | Individual |
| Full Name | DR. KEVIN WAYNE BRODER |
| Credential | MD |
| Practice Address |
4510 Executive Drive Suite 200 San Diego CA 92121 |
| Practice Telephone | 8584537224 |
| Practice Fax Number | 8584537268 |
| Mailing Telephone | 8584537224 |
| Mailing Fax Number | 8584537268 |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2012-09-05 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208200000X | Plastic Surgery | A82409 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 00A824090 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528247855 | Kevin Broder | Internal Medicine | 420 Delaware St Se, Mmc 284, Minneapolis, MN 55455-0341 | 2007-11-02 |
| Street Address |
4510 EXECUTIVE DRIVE SUITE 200 |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92121 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386636348 | Charles N Rudolph | Internal Medicine | 4510 Executive Drive, Suite 125, San Diego, CA 92121 | 2005-08-16 |
| 1629628730 | Hannah Rovazzini | Marriage & Family Therapist | 4510 Executive Drive, San Diego, CA 92121 | 2019-09-19 |
| 1619111440 | Gabriel Schnickel | Transplant Surgery | 4510 Executive Drive, Plaza 7, San Diego, CA 92121-3021 | 2009-04-23 |
| 1972710663 | Kambiz Kohani | Dentist | 4510 Executive Drive, Suite #205, San Diego, CA 92121 | 2007-05-16 |
| 1356401566 | Bonebuilders Medical Clinic | Orthopaedic Surgery | 4510 Executive Drive, Suite 125, San Diego, CA 92121 | 2006-12-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225644917 | Anna Hand | Physical Therapist | 5945 Pacific Center Blvd Bldg #510, San Diego, CA 92121 | 2020-09-18 |
| 1972138030 | Lamarr Joyner | Licensed Vocational Nurse | 5930 Conerstone Court West, Suite 300, San Diego, CA 92121 | 2020-03-10 |
| 1396383212 | La Jolla Professional Plastic Surgery | Plastic Surgery | 4510 Executive Dr. Suite 105, San Diego, CA 92121 | 2019-12-11 |
| 1841852472 | Unmanned Systems Operations Group | Air Carrier | 4655 Executive Dr., Suite 700, San Diego, CA 92121 | 2019-07-03 |
| 1861051922 | Grace Getchell | Behavior Technician | 3978 Sorrento Valley Blvd. #100, San Diego, CA 92121 | 2019-06-11 |
| 1720643299 | Megan Jean Bathen | Behavior Technician | Cortica Behavioral Inc., 7090 Miratech Dr., San Diego, CA 92121 | 2019-05-09 |
| 1346804366 | Daniel Melita | Massage Therapist | 11689 Sorrento Valley Rd Ste Q, San Diego, CA 92121 | 2019-04-25 |
| 1831674464 | Stepahnie Becerra | Behavior Technician | 3978 Sorrento Valley Blvd Suite 100, San Diego, CA 92121 | 2018-09-28 |
| 1265915466 | Ailyn Martinez | Behavior Technician | 3978 Sorrento Valley Bldv, 100, San Diego, CA 92121 | 2018-09-13 |
| 1790265163 | Genben Lifesciences Corporation | Public Health or Welfare | 6370 Lusk Blvd Ste F205, San Diego, CA 92121 | 2018-08-15 |
| Find all providers in zip 92121 | ||||
| Taxonomy Code | 208200000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Plastic Surgery |
| A plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk and external genitalia or cosmetic enhancement of these areas of the body. Cosmetic surgery is an essential component of plastic surgery. The plastic surgeon uses cosmetic surgical principles to both improve overall appearance and to optimize the outcome of reconstructive procedures. The surgeon uses aesthetic surgical principles not only to improve undesirable qualities of normal structures but in all reconstructive procedures as well. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Plastic Surgery, 2007. http://www.abplsurg.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Plastic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396383212 | La Jolla Professional Plastic Surgery | Plastic Surgery | 4510 Executive Dr. Suite 105, San Diego, CA 92121 | 2019-12-11 |
| 1790341832 | Frederic Jerome Kolb | Plastic Surgery | 200 W Arbor Dr # Mc8890, San Diego, CA 92103-1911 | 2019-05-14 |
| 1891213245 | Rishi Jindal Md Inc | Plastic Surgery | 12264 El Camino Real Ste 101, San Diego, CA 92130-3060 | 2017-09-06 |
| 1548530454 | Dan Sullivan Smith | Plastic Surgery | 5988 Saint Denis Ter, San Diego, CA 92120-3015 | 2012-01-09 |
| 1134453640 | Gary Haves Manchester | Plastic Surgery | 3720 Fourth Ave, San Diego, DC 92110-4763 | 2009-09-30 |
| 1992937304 | Stuart B Kincaid Md, Facs, Apc | Plastic Surgery | 8929 University Center Ln Ste 201, San Diego, CA 92122-1008 | 2009-08-18 |
| 1851528137 | Aram Harijan | Plastic Surgery | 1830 Reed Ave Apt 2, San Diego, CA 92109 | 2009-06-15 |
| 1760636534 | Ahmad Nazih Saad | Plastic Surgery | 5370 Toscana Way, Unit H212, San Diego, CA 92122-5656 | 2008-11-06 |
| 1528239761 | Innovative Plastic & Cosmetic Surgery Inc | Plastic Surgery | 6610 Flanders Dr, Suite 101, San Diego, CA 92121-3940 | 2008-03-16 |
| 1316069503 | Salvatore John Pacella IIi | Plastic Surgery | 12395 El Camino Real Ste 112, San Diego, CA 92130-3084 | 2007-04-06 |
| Find all providers in SAN DIEGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.