Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 11723472-1205 | UT |
Y | 207XS0117X | Orthopaedic Spine Surgeon | A139792 | CA |
NPI | 1053720565 |
---|---|
Provider Name | Dr. Jon Adam Kimball |
First Address | Los Angeles, CA 90031-0309 |
Second Address | Los Angeles, CA 90033-5322 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2014 |
Last Update Date | 19/06/2020 |