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General NPI Number Information
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NPI Number | 1629902689
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Entity Type | Individual
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Provider Name | JAMES KILGORE
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Gender | Male
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Dates
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Enumeration Date | 06/12/2026
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Last Update Date | 06/12/2026
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Provider Practice Location Address
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Address Line | 290 S PROSPECT AVE STE A
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City | TUSTIN
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State | CA
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Zip | 92780-1523
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Country | US
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Telephone | 949-312-1232
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Fax |
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Provider Business Mailing Address
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Address Line | 412 N EMILY ST
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City | ANAHEIM
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State | CA
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Zip | 92805-3028
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Country | US
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Telephone | 909-680-7372
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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