Healthcare Provider Details

I. General information

NPI: 1659448918
Provider Name (Legal Business Name): KATHRYN CARR WHITE M.D., M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 E COLUMBIA ST STE 201455E
LONG BEACH CA
90806-1602
US

IV. Provider business mailing address

701 E 28TH ST STE 200
LONG BEACH CA
90806-2784
US

V. Phone/Fax

Practice location:
  • Phone: 323-268-8391
  • Fax: 858-633-4702
Mailing address:
  • Phone: 844-822-4646
  • Fax: 562-933-0487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA67922
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: