1205135878 NPI number — JAMES T LONDON M D A PROFESSIONAL CORPORATION

Table of content: (NPI 1205135878)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205135878 NPI number — JAMES T LONDON M D A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES T LONDON M D A PROFESSIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1205135878
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1360 W 6TH ST
Provider Second Line Business Mailing Address:
SUITE 305
Provider Business Mailing Address City Name:
SAN PEDRO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90732-3569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-833-2406
Provider Business Mailing Address Fax Number:
310-519-8936

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1360 W 6TH ST
Provider Second Line Business Practice Location Address:
SUITE 305
Provider Business Practice Location Address City Name:
SAN PEDRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90732-3569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-833-2406
Provider Business Practice Location Address Fax Number:
310-519-8936
Provider Enumeration Date:
03/22/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LONDON
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
310-833-2406

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: A23448 . This is a "TYPE I NPI : 1366500647" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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