Provider Demographics
NPI:1609559921
Name:KEVIN WETHEY, M.D. A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:KEVIN WETHEY, M.D. A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WETHEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-460-8733
Mailing Address - Street 1:750 N DIAMOND BAR BLVD STE 212
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-1023
Mailing Address - Country:US
Mailing Address - Phone:909-460-8733
Mailing Address - Fax:909-752-9605
Practice Address - Street 1:750 N DIAMOND BAR BLVD STE 212
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-1023
Practice Address - Country:US
Practice Address - Phone:909-460-8733
Practice Address - Fax:909-752-9605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-11
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty