Healthcare Provider Details

I. General information

NPI: 1831612340
Provider Name (Legal Business Name): CHRISTOPHER JAMES KINGSLEY MS,ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2017
Last Update Date: 07/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 N NASH ST
EL SEGUNDO CA
90245-2818
US

IV. Provider business mailing address

644 HERMOSA AVE
HERMOSA BEACH CA
90254
US

V. Phone/Fax

Practice location:
  • Phone: 310-535-4526
  • Fax: 310-535-4525
Mailing address:
  • Phone: 310-535-4526
  • Fax: 310-535-4525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: