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General NPI Number Information
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NPI Number | 1962123471
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Entity Type | Individual
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Provider Name | JOHN KEVIN THOMAS SPECIALIST
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Gender | Male
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Dates
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Enumeration Date | 09/05/2022
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Last Update Date | 09/05/2022
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Provider Practice Location Address
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Address Line | 61 LAKEWOOD CENTER MALL STE J
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City | LAKEWOOD
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State | CA
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Zip | 90712-2417
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Country | US
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Telephone | 562-416-1656
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Fax |
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Provider Business Mailing Address
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Address Line | 15620 S NORMANDIE AVE APT J
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City | GARDENA
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State | CA
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Zip | 90247-4041
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Country | US
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Telephone | 562-416-1656
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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 | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number | B78253
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License Number State | CA
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