Healthcare Provider Details

I. General information

NPI: 1922945203
Provider Name (Legal Business Name): KMJ MEDICAL GROUP INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 GROSSMONT CENTER DR
LA MESA CA
91942-3077
US

IV. Provider business mailing address

PO BOX 1770
LA MESA CA
91944-1770
US

V. Phone/Fax

Practice location:
  • Phone: 619-949-0838
  • Fax: 619-655-4714
Mailing address:
  • Phone: 619-464-1165
  • Fax: 619-567-1011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: KARL MONTE JACOBS
Title or Position: MD/OWNER
Credential: MD
Phone: 619-949-0838