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General NPI Number Information
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NPI Number | 1831612340
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Entity Type | Individual
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Provider Name | CHRISTOPHER JAMES KINGSLEY MS,ATC
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Gender | Male
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Dates
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Enumeration Date | 07/18/2017
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Last Update Date | 07/18/2017
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Provider Practice Location Address
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Address Line | 555 N NASH ST
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City | EL SEGUNDO
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State | CA
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Zip | 90245-2818
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Country | US
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Telephone | 310-535-4526
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Fax | 310-535-4525
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Provider Business Mailing Address
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Address Line | 644 HERMOSA AVE
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City | HERMOSA BEACH
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State | CA
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Zip | 90254
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Country | US
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Telephone | 310-535-4526
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Fax | 310-535-4525
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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 | CA
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