Healthcare Provider Details

I. General information

NPI: 1972964294
Provider Name (Legal Business Name): ALLERGY AND ASTHMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2016
Last Update Date: 03/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5776 RUFFIN RD
SAN DIEGO CA
92123-1013
US

IV. Provider business mailing address

5776 RUFFIN RD
SAN DIEGO CA
92123-1013
US

V. Phone/Fax

Practice location:
  • Phone: 617-517-9100
  • Fax: 760-765-2123
Mailing address:
  • Phone: 617-517-9100
  • Fax: 760-765-2123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberC28014
License Number StateCA

VIII. Authorized Official

Name: DR. JAMES P KEMP
Title or Position: RESEARCH DIRECTOR
Credential: MD
Phone: 619-517-9100