MEDICARE: KENDALL FRYER PA

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
1	363A00000X	Physician Assistant		CA

General Provider Information

NPI Number	:	1225903453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDALL FRYER PA

Provider Business Mailing Address
First Line	:	765 MEDICAL CENTER CT STE 211
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91911-6600
Country	:	US
Telephone Number	:	619-616-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	765 MEDICAL CENTER CT STE 211
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91911-6600
Country	:	US
Telephone Number	:	616-619-2100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2025
Last Update Date	:	06/15/2026

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Directions to “ KENDALL FRYER PA” Practice Location

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