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General NPI Number Information
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NPI Number | 1285094094
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Entity Type | Organization
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Legal Business Name | LOVE KIDS LLC
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Dates
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Enumeration Date | 03/07/2016
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Last Update Date | 03/07/2016
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Provider Practice Location Address
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Address Line | 14300 GALLANT FOX LN 203
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City | BOWIE
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State | MD
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Zip | 20715-4003
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Country | US
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Telephone | 301-262-4784
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Fax | 301-262-2767
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Provider Business Mailing Address
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Address Line | 14300 GALLANT FOX LN 203
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City | BOWIE
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State | MD
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Zip | 20715-4003
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Country | US
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Telephone | 301-262-4784
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Fax | 301-262-2767
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Authorized Official
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Title or Position | CEO
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Name | YVONNE JACKSON
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Credential | M.D.
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Telephone | 301-262-4784
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | D0050706
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License Number State | MD
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