Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | G89360 | CA |
NPI | 1043325939 |
---|---|
Provider Name | Dr. Revere Philip Kinkel |
First Address | San Diego, CA 92193-2410 |
Second Address | San Diego, CA 92103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 10/07/2018 |