Individual
KEVIN MICHEAL SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10833 LE CONTE AVE, LOS ANGELES, CA 90095-3075
(310) 825-5296
(310) 825-9524
Mailing address
10833 LE CONTE AVE, LOS ANGELES, CA 90095-3075
(310) 825-5296
(310) 825-9524
Taxonomy
Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
Primary
G64023
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G640230
—
CA
Enumeration date
06/27/2006
Last updated
08/27/2013
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