{"npi":"1578736724","type":"NPI-1","status":"active","name":{"display":"Dr. Kevin Belasco D.O.","other":[],"first":"KEVIN","last":"BELASCO","middle":"TATE","credential":"D.O."},"specialty":{"primary_taxonomy":"207N00000X","primary_taxonomy_description":"Dermatology","slug":"dermatology","schema_org_specialty":"Dermatologic","all":[{"code":"207N00000X","description":"Dermatology","primary":false,"state":"WI","license":"51343021"},{"code":"207N00000X","description":"Dermatology","primary":true,"state":"CA","license":"20A12076"},{"code":"207N00000X","description":"Dermatology","primary":false,"state":"NV","license":"DO1741"}]},"addresses":[{"purpose":"LOCATION","street_1":"1501 SUPERIOR AVE STE 115","city":"NEWPORT BEACH","state":"CA","postal_code":"926633606","country_code":"US","phone":"9496407546","fax":"9496407547"},{"purpose":"MAILING","street_1":"1501 SUPERIOR AVE STE 115","city":"NEWPORT BEACH","state":"CA","postal_code":"926633606","country_code":"US","phone":"9496407546","fax":"9496407547"}],"license":{"state":"CA","number":"20A12076"},"identifiers":[{"type_code":"01","label":"Other","value":"001417140","state":"WI","issuer":"MEDICARE"},{"type_code":"01","label":"Other","value":"P00690402","state":"WI","issuer":"RAILROAD MEDICARE"},{"type_code":"01","label":"Other","value":"51343-021","state":"WI","issuer":"STATE LICENSE"},{"type_code":"05","label":"Medicaid","value":"1578736724","state":"WI","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"I20120321000578","type_code":"14-07","type_desc":"PRACTITIONER - DERMATOLOGY","state":"CA","pac_id":"5496829103"}]},"enumeration_date":"2008-04-09","last_updated":"2023-03-07","_meta":{"source":"NPPES","snapshot_date":"2023-03-07","doc_url":"https://findmynpi.com/api"}}