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General NPI Number Information
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NPI Number | 1760200356
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Entity Type | Organization
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Legal Business Name | KINGSTON HEALTH GROUP
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Dates
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Enumeration Date | 10/01/2024
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Last Update Date | 11/25/2025
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Provider Practice Location Address
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Address Line | 955 CARRILLO DR STE 900
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City | LOS ANGELES
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State | CA
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Zip | 90048-5472
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Country | US
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Telephone | 424-502-0336
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Fax |
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Provider Business Mailing Address
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Address Line | 955 CARRILLO DR STE 900
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City | LOS ANGELES
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State | CA
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Zip | 90048-5472
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL JACOB GHODS
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Credential |
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Telephone | 424-258-0124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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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 | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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