# CHILDREN'S SPECIALISTS OF SAN DIEGO - DIV OF SURG

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CHILDREN'S SPECIALISTS OF SAN DIEGO
- **Other names:** Children's Associated Medical Group
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1144387614
- **Legal business name:** CHILDREN'S SPECIALISTS OF SAN DIEGO
- **Authorized official:** HERBERT C. KIMMONS JR. M.D. (PRESIDENT)
- **Authorized official phone:** (858) 966-8567

## Contact information

- **Practice address:** 8010 FROST ST, SUITE 414, SAN DIEGO, CA 92123-2778
- **Practice address phone:** (858) 966-7711
- **Mailing address:** 3860 CALLE FORTUNADA, SUITE 210, SAN DIEGO, CA 92123-4800
- **Mailing address phone:** (858) 309-6303
- **Mailing address fax:** (858) 309-6301

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 2086S0120X | Pediatric Surgery Physician | — | NULL | Yes |
| 2086S0120X | Pediatric Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/03/2007
- **Last updated:** 04/22/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GR0083550 | — | CA |