Individual
JONATHAN KISTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1001 NEEDHAM ST, MODESTO, CA 95354-0730
(209) 569-0373
(209) 529-8519
Mailing address
1001 NEEDHAM ST, MODESTO, CA 95354-0730
(209) 569-0373
(209) 529-8519
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
A73938
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A73938
MEDICAL LICENSE
CA
Enumeration date
05/17/2006
Last updated
11/06/2023
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