DR. KEVIN CHARLES SHANNON M.D. NPI 1356470314

NPI Information

  • NPI: 1356470314
  • Provider Name: DR. KEVIN CHARLES SHANNON, M.D.
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 1454 E 2ND ST
    SAN BERNARDINO, CA
    ZIP 92408
  • Phone: (909) 382-7146

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NPI Details

DR. Kevin Charles Shannon, M.D. is a family medicine in San Bernardino, CA with 41 years of experience. The provider is 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. DR. Kevin Charles Shannon, M.D. NPI is 1356470314. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIVERSITY OF ILLINOIS COLLEGE OF MED (CHI/PEOR/ROCK/CHM-URB)
Graduation Year:1985

The provider's business location address is:

1454 E 2ND ST
SAN BERNARDINO, CA
ZIP 92408-118
Phone: (909) 382-7146
Fax: (909) 382-7101

The NPI 1356470314 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 3/5/2007 and was last updated on 4/15/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily Medicine11096NEW HAMPSHIREYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
10RE6020MEDICAIDVERMONT
2RE602001MEDICARE PINNEW HAMPSHIRE
3E80725MEDICARE UPIN
430201226MEDICAIDNEW HAMPSHIRE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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