1447317771 NPI number — DR. KIMBERLY ANN CHARLTON M.D.

Table of content: DR. MARION L VETTER MD (NPI 1841205713)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447317771 NPI number — DR. KIMBERLY ANN CHARLTON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHARLTON
Provider First Name:
KIMBERLY
Provider Middle Name:
ANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447317771
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6255 W SUNSET BLVD FL 21
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90028-7422
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-498-6674
Provider Business Mailing Address Fax Number:
855-312-7678

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 S GRAND AVE STE 801
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90015-3068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-741-9727
Provider Business Practice Location Address Fax Number:
213-741-0867
Provider Enumeration Date:
01/03/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  DR.0051678 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: MD11530 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0804X , with the licence number: DR.0051678 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: G88843 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A0232304 . This is a "HMSA-QUEST" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 74659014 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: MD11530 . This is a "MDX HAWAII" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 990298651-96706-E049 . This is a "TRICARE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 961761 . This is a "UNIVERSITY HEALTH ALLIANC" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 00A0232304 . This is a "HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 1236 . This is a "ALOHACARE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 523317-01 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".