Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | A64097 | CA |
Y | 111NI0900X | Internist | A64097 | CA |
N | 207RI0200X | Infectious Disease | 68919 | GA |
N | 207RI0200X | Infectious Disease | A64097 | CA |
NPI | 1023208683 |
---|---|
Provider Name | Kinji Lothario Hawthorne |
First Address | La Quinta, CA 92253-8858 |
Second Address | La Quinta, CA 92253-8858 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2007 |
Last Update Date | 22/06/2020 |