Provider Demographics
NPI:1114216611
Name:KITCHIN, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:KITCHIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 AMIFORD DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-4204
Mailing Address - Country:US
Mailing Address - Phone:619-804-6137
Mailing Address - Fax:
Practice Address - Street 1:720 AMIFORD DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107-4204
Practice Address - Country:US
Practice Address - Phone:619-804-6137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACO36013273R00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
No282N00000XHospitalsGeneral Acute Care Hospital