Healthcare Provider Details

I. General information

NPI: 1245751932
Provider Name (Legal Business Name): JAMES J KINCHSULAR A PODIATRY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 J ST STE 270
SACRAMENTO CA
95819-3666
US

IV. Provider business mailing address

3939 J ST STE 270
SACRAMENTO CA
95819-3666
US

V. Phone/Fax

Practice location:
  • Phone: 916-454-3668
  • Fax: 916-454-9255
Mailing address:
  • Phone: 916-454-3668
  • Fax: 916-454-9255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4913
License Number StateCA

VIII. Authorized Official

Name: WALTER SPARKMAN
Title or Position: BILLER
Credential:
Phone: 916-640-0515