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NPI Code Detail

MEDICARE: JONATHAN KISTLER M.D.

MEDICARE: JONATHAN KISTLER M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry PhysicianA73938CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1A73938OTHERCAMEDICAL LICENSE

General Provider Information

NPI Number : 1033161740
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN KISTLER M.D.
Provider Business Mailing Address
First Line : 1001 NEEDHAM ST
Second Line :
City : MODESTO
State : CA
Zip : 95354-0730
Country : US
Telephone Number : 209-569-0373
Fax Number : 209-529-8519
Provider Business Practice Location Address
First Line : 1001 NEEDHAM ST
Second Line :
City : MODESTO
State : CA
Zip : 95354-0730
Country : US
Telephone Number : 209-569-0373
Fax Number : 209-529-8519
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2006
Last Update Date : 11/06/2023

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Directions to “ JONATHAN KISTLER M.D.” Practice Location

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