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750 N Diamond Bar Blvd Ste 212 Diamond Bar CA 91765-1023 | |
| (909) 460-8733 | |
| (909) 752-9605 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 750 N Diamond Bar Blvd Ste 212, Diamond Bar, California |
| Authorized Official Name and Position | Kevin Wethey (PSYCHIATRIST) |
| Authorized Official Contact | 9094608733 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
750 N Diamond Bar Blvd Ste 212 Diamond Bar CA 91765-1023 Ph: (909) 460-8733 | 750 N Diamond Bar Blvd Ste 212 Diamond Bar CA 91765-1023 Ph: (909) 460-8733 |
| NPI Number | 1609559921 |
|---|---|
| Provider Enumeration Date | 08/11/2023 |
| Last Update Date | 05/03/2024 |
| Certification Date | 05/03/2024 |
| Medicare PECOS PAC ID | 5496298366 |
|---|---|
| Medicare Enrollment ID | O20240620000114 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609559921 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Kevin Mathew Wethey |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1306378559 PECOS PAC ID: 6800221482 Enrollment ID: I20200818001668 |
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