Healthcare Provider Details

I. General information

NPI: 1942403035
Provider Name (Legal Business Name): JAMES ALEXANDER MCKINNELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST FL 2 DIVISION OF I.D.; 2ND FLOOR RB-2
TORRANCE CA
90502-2004
US

IV. Provider business mailing address

3400 LOMITA BLVD SUITE 104
TORRANCE CA
90505-4909
US

V. Phone/Fax

Practice location:
  • Phone: 310-222-3814
  • Fax:
Mailing address:
  • Phone: 310-326-5648
  • Fax: 310-326-5679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA95978
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberA95978
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: