Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | A75769 | CA |
Y | 208600000X | Surgeon | A75769 | CA |
NPI | 1023080033 |
---|---|
Provider Name | Mathias John Kill |
First Address | San Diego, CA 92104-4934 |
Second Address | San Diego, CA 92134-3098 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2006 |
Last Update Date | 12/12/2012 |