Organization
CHILDREN'S SPECIALISTS OF SAN DIEGO - DIV OF ENT
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
3030 CHILDRENS WAY, SUITE 402, SAN DIEGO, CA 92123-4232
(858) 309-7701
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
207Y00000X
Otolaryngology Physician
—
—
207YP0228X
Pediatric Otolaryngology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR006886F
—
CA
Enumeration date
01/03/2007
Last updated
04/22/2008
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