Provider Demographics
NPI:1548215288
Name:MOLLENKAMP, JAMES SINCLAIR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:SINCLAIR
Last Name:MOLLENKAMP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:23600 TELO AVE
Mailing Address - Street 2:STE 2200
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4035
Mailing Address - Country:US
Mailing Address - Phone:310-534-8400
Mailing Address - Fax:310-534-0463
Practice Address - Street 1:23600 TELO AVE
Practice Address - Street 2:STE 2200
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4035
Practice Address - Country:US
Practice Address - Phone:310-534-8400
Practice Address - Fax:310-534-0463
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHAM4338542208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A35090Medicare UPIN
CAW11165Medicare ID - Type Unspecified