Healthcare Provider Details

I. General information

NPI: 1083155824
Provider Name (Legal Business Name): JMK COMMUNITY HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2017
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14111 VAN NESS AVE SUITE 5
GARDENA CA
90249-2950
US

IV. Provider business mailing address

1112 N SANTA FE AVE
COMPTON CA
90221-1427
US

V. Phone/Fax

Practice location:
  • Phone: 424-396-3412
  • Fax: 424-396-3427
Mailing address:
  • Phone: 310-638-1100
  • Fax: 424-396-3427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. JEANETTE MONIQUE KIDD
Title or Position: CEO
Credential: FNP-C
Phone: 424-396-3412