Provider Demographics
NPI:1225069123
Name:JENKIN, FREDERICK D (PHYSICIAN)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:D
Last Name:JENKIN
Suffix:
Gender:M
Credentials:PHYSICIAN
Other - Prefix:
Other - First Name:FREDERICK
Other - Middle Name:D
Other - Last Name:JENKIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHYSICIAN
Mailing Address - Street 1:PO BOX 511405
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-7960
Mailing Address - Country:US
Mailing Address - Phone:866-284-2771
Mailing Address - Fax:800-334-1041
Practice Address - Street 1:7050 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-1535
Practice Address - Country:US
Practice Address - Phone:858-774-5157
Practice Address - Fax:858-731-1021
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5034207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine