Provider Demographics
NPI:1144216284
Name:KINGSBURY, ARTHUR GRANT (MD)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:GRANT
Last Name:KINGSBURY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:A. GRANT
Other - Middle Name:
Other - Last Name:KINGSBURY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4060 4TH AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2116
Mailing Address - Country:US
Mailing Address - Phone:619-298-2900
Mailing Address - Fax:
Practice Address - Street 1:4060 4TH AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2116
Practice Address - Country:US
Practice Address - Phone:619-298-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64822207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG95835Medicare UPIN