Provider Demographics
NPI:1336642164
Name:KEMP, JUSTINE (MD)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:KEMP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5323 HARRY HINES BLVD STOP 7200
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-2632
Mailing Address - Country:US
Mailing Address - Phone:214-648-4729
Mailing Address - Fax:214-648-8025
Practice Address - Street 1:5323 HARRY HINES BLVD STOP 7200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-2600
Practice Address - Country:US
Practice Address - Phone:214-648-4729
Practice Address - Fax:214-648-8025
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-18
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP100680422085R0202X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology