Organization
CHILDREN'S SPECIALIST OF SAN DIEGO - DIV OF DERM
Active
Parent organization
CHILDREN'S SPECIALISTS OF SAN DIEGO
Other names
Children's Associated Medical Group
Organization subpart
Yes
Provider details
NPI number
Legal business name
CHILDREN'S SPECIALISTS OF SAN DIEGO
Authorized official
HERBERT C. KIMMONS JR. M.D. (PRESIDENT)
(858) 966-8567
Entity
Organization
Contact information
Practice address
8010 FROST ST, SUITE 602, SAN DIEGO, CA 92123-2778
(858) 966-6795
Mailing address
3860 CALLE FORTUNADA, SUITE 210, SAN DIEGO, CA 92123-4800
(858) 309-6303
(858) 309-6301
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
—
207NP0225X
Pediatric Dermatology Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR006886A
—
CA
Enumeration date
01/02/2007
Last updated
04/22/2008
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