Provider Demographics
NPI:1730280298
Name:MCKITTY, SIMONE A (MD)
Entity Type:Individual
Prefix:
First Name:SIMONE
Middle Name:A
Last Name:MCKITTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3440 LOMITA BLVD
Mailing Address - Street 2:STE 442
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4882
Mailing Address - Country:US
Mailing Address - Phone:310-530-5451
Mailing Address - Fax:310-530-3070
Practice Address - Street 1:4660 KENMORE AVE
Practice Address - Street 2:STE 500
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-1300
Practice Address - Country:US
Practice Address - Phone:703-370-0073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC127807207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC021395C01Medicare PIN