Provider Demographics
NPI:1609070242
Name:KIOUS, JENNIFER PREHN (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:PREHN
Last Name:KIOUS
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 1:1245 16TH ST
Mailing Address - Street 2:SUITE 125
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1235
Mailing Address - Country:US
Mailing Address - Phone:310-319-4377
Mailing Address - Fax:310-319-4425
Practice Address - Street 1:1245 16TH ST
Practice Address - Street 2:SUITE 125
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1235
Practice Address - Country:US
Practice Address - Phone:310-319-4377
Practice Address - Fax:310-319-4425
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94614207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A946140Medicaid
CAWA94614BMedicare PIN
CAWA94614AMedicare PIN