Individual
KEVIN DEAN HENGEVELD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2720 SUNSET BLVD, WEST COLUMBIA, SC 29169-4810
(803) 791-2460
(803) 791-2519
Mailing address
PO BOX 6069, WEST COLUMBIA, SC 29171-6069
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
5601004531
MI
363AS0400X
Surgical Physician Assistant
Primary
2387
SC
Other
Enumeration date
07/16/2006
Last updated
11/06/2020
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