Healthcare Provider Details

I. General information

NPI: 1033390463
Provider Name (Legal Business Name): PHILLIP GORDON MCKINLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 N PRAIRIE AVE STE 401
INGLEWOOD CA
90301-4506
US

IV. Provider business mailing address

5219 REYNIER AVE
LOS ANGELES CA
90056-1018
US

V. Phone/Fax

Practice location:
  • Phone: 310-693-0483
  • Fax:
Mailing address:
  • Phone: 310-410-0190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG80553
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG80553
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: