Healthcare Provider Details

I. General information

NPI: 1750365045
Provider Name (Legal Business Name): CHARLES KITCHENS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1185 OLIVE HILL LN
NAPA CA
94558-2170
US

IV. Provider business mailing address

1185 OLIVE HILL LN
NAPA CA
94558-2170
US

V. Phone/Fax

Practice location:
  • Phone: 707-224-5935
  • Fax: 707-294-2526
Mailing address:
  • Phone: 707-224-5935
  • Fax: 707-294-2526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberC33961
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberC33961
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License NumberC33961
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberC33961
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: