Provider Demographics
NPI:1073052023
Name:JAMES H. KIMBER, PHYSICIAN ASSISTANT, INC.
Entity Type:Organization
Organization Name:JAMES H. KIMBER, PHYSICIAN ASSISTANT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:KIMBER
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:858-513-1833
Mailing Address - Street 1:12547 EL CAMINO REAL
Mailing Address - Street 2:UNIT E
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-4053
Mailing Address - Country:US
Mailing Address - Phone:858-513-1833
Mailing Address - Fax:858-513-1838
Practice Address - Street 1:7901 FROST ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2701
Practice Address - Country:US
Practice Address - Phone:858-939-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17397363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty