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General NPI Number Information
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NPI Number | 1083155824
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Entity Type | Organization
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Legal Business Name | JMK COMMUNITY HEALTH CENTER, INC
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Dates
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Enumeration Date | 03/13/2017
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Last Update Date | 11/06/2019
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Provider Practice Location Address
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Address Line | 14111 VAN NESS AVE SUITE 5
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City | GARDENA
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State | CA
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Zip | 90249-2950
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Country | US
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Telephone | 424-396-3412
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Fax | 424-396-3427
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Provider Business Mailing Address
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Address Line | 1112 N SANTA FE AVE
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City | COMPTON
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State | CA
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Zip | 90221-1427
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Country | US
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Telephone | 310-638-1100
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Fax | 424-396-3427
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Authorized Official
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Title or Position | CEO
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Name | MS. JEANETTE MONIQUE KIDD
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Credential | FNP-C
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Telephone | 424-396-3412
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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