DR. KEVIN CHARLES SHANNON (NPI# 1356470314) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356470314 |
| Entity Type | Individual |
| Full Name | DR. KEVIN CHARLES SHANNON |
| Credential | M.D. |
| Practice Address |
1454 E 2nd St San Bernardino CA 92408-0118 |
| Practice Telephone | 9093827146 |
| Practice Fax Number | 9093827101 |
| Mailing Telephone | 9093827146 |
| Mailing Fax Number | 9093827101 |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2013-04-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 11096 | NH | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VT | 0RE6020 | 05 | |
| NH | 30201226 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922104728 | Kevin M. Shannon | Pediatrics | 500 Parnassus Ave # Hse-302, San Francisco, CA 94143-2203 | 2006-09-16 |
| 1881697894 | Kevin J Shannon | Internal Medicine | 15990 Medical Dr S, Findlay, OH 45840-8894 | 2005-05-23 |
| 1629005368 | Kevin Micheal Shannon | Pediatrics | 10833 Le Conte Ave, Los Angeles, CA 90095-3075 | 2006-06-27 |
| Street Address |
1454 E 2ND ST |
| City | SAN BERNARDINO |
| State | CA |
| Zip Code | 92408-0118 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679575682 | Joycelyn Mallari | Pharmacist | 1454 E 2nd St, San Bernardino, CA 92408-0118 | 2005-08-10 |
| 1679031595 | Genice L Schumann | Nurse Practitioner | 1454 E 2nd St, San Bernardino, CA 92408-0118 | 2019-03-10 |
| 1851704605 | Hang Lee | Nurse Practitioner | 1454 E 2nd St, San Bernardino, CA 92408-0118 | 2014-06-10 |
| 1407282676 | Maryellen Westerberg | Dietitian, Registered | 1454 E 2nd St, San Bernardino, CA 92408-0118 | 2013-09-19 |
| 1194048835 | Daniel Ninan | Dentist | 1454 E 2nd St, San Bernardino, CA 92408-0118 | 2010-03-09 |
| 1295907392 | Susan O'brien Wallace | Counselor | 1454 E 2nd St, San Bernardino, CA 92408-0118 | 2008-03-28 |
| 1528241916 | Roxana Pomeroy | Dentist | 1454 E 2nd St, San Bernardino, CA 92408-0118 | 2007-12-09 |
| 1922298744 | Linda Marie War | Counselor | 1454 E 2nd St, San Bernardino, CA 92408-0118 | 2007-07-27 |
| 1164612982 | Patrick Tobin | Counselor | 1454 E 2nd St, San Bernardino, CA 92408-0118 | 2007-07-27 |
| 1689896821 | Donna Smith-burgess | Marriage & Family Therapist | 1454 E 2nd St, San Bernardino, CA 92408-0118 | 2007-05-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073124681 | Valeria Armentilla Cecena | Student in an Organized Health Care Education/Training Program | 1950 Sunwest Ln., San Bernardino, CA 92408 | 2020-08-17 |
| 1588272066 | Horizon Therapy Services | Physical Therapist | 418 East Vanderbilt, San Bernardino, CA 92408 | 2020-07-21 |
| 1821627639 | Bl Anderson Medical Corporation | Emergency Medicine | 473 E Carnegie Dr., Ste 200, San Bernardino, CA 92408 | 2020-04-03 |
| 1922648104 | Infinite Hope Hospice Corp | Hospice Care, Community Based | 225 W Hospitality Ln Suite 305, San Bernardino, CA 92408 | 2020-01-15 |
| 1689210775 | Inland Empire Community Outreach Center | Counselor | 473 East Carnegie Drive, Suite 200, San Bernardino, CA 92408 | 2019-11-23 |
| 1992347801 | Care Marriage and Family Therapists, Inc. | Marriage & Family Therapist | 1881 Commercenter Drive E, Suite 232, San Bernardino, CA 92408 | 2019-10-11 |
| 1366084360 | Theraville Counseling Services, A Licensed Clinical Social Worker Corp | Social Worker | 155 W Hospitality Ln Ste 245, San Bernardino, CA 92408 | 2019-10-10 |
| 1548730419 | Adriana Alcaraz | Behavior Technician | 473 E Carnegie, Ste 200, San Bernardino, CA 92408 | 2018-12-04 |
| 1811467889 | Xavier J Molina-williams | Behavior Technician | 476 E Carnegie Drive, Ste 200, San Bernardino, CA 92408 | 2018-12-03 |
| 1780153148 | Gillian Washington | Behavior Technician | 473 E Carnegie Dr, Ste 200, Riverside, CA 92408 | 2018-11-15 |
| Find all providers in zip 92408 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346803954 | Community Health Care Foundation | Family Medicine | 406 E Vanderbilt Way Bldg 8, San Bernardino, CA 92408-3552 | 2019-04-18 |
| 1558837153 | Inland Empire Health Centers | Family Medicine | 1374 N Waterman Ave, San Bernardino, CA 92404-5313 | 2018-10-22 |
| 1356846281 | Maria Socorro Ruiz-rodriguez | Family Medicine | 850 W Highland Ave Ste A, San Bernardino, CA 92405-3855 | 2018-03-23 |
| 1588041859 | Mai-linh Ngoc Tran | Family Medicine | 1455 3rd Ave, San Bernardino, CA 92408 | 2015-05-06 |
| 1932514239 | Sarah Kin | Family Medicine | 1499 E Highland Ave, San Bernardino, CA 92404-4611 | 2014-06-25 |
| 1689930570 | Healthy Baby & Me, A Medical Corporation | Family Medicine | 1666 Medical Center Dr Ste 3, San Bernardino, CA 92411-1257 | 2012-04-05 |
| 1649548462 | Ralph R. Vega M.d., Dabfp Inc | Family Medicine | 1666 N. Medical Center Dr, Suite 2, San Bernardino, CA 92411-1257 | 2011-12-07 |
| 1477860187 | Molina Healthcare of California | Family Medicine | 170 East Highland Ave, San Bernardino, CA 92404-3658 | 2010-09-02 |
| 1043441900 | Healthy Preferred Inc | Family Medicine | 475 S Arrowhead Ave, Ste D, San Bernardino, CA 92408-1347 | 2009-07-27 |
| 1568629889 | Tae Kyu Kim | Family Medicine | 275 W Hospitality Ln Ste 200, San Bernardino, CA 92408-3238 | 2008-05-22 |
| Find all providers in SAN BERNARDINO | ||||
| City | SAN BERNARDINO |
| Zip Code | 92408 |
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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.