Provider Demographics
NPI:1750456349
Name:KINGSLEY, ANTHONY MCDONALD (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:MCDONALD
Last Name:KINGSLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17203 MORNINGRAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-8322
Mailing Address - Country:US
Mailing Address - Phone:562-860-1846
Mailing Address - Fax:560-860-8998
Practice Address - Street 1:10301 GARVEY AVE STE 100
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-2180
Practice Address - Country:US
Practice Address - Phone:626-448-0468
Practice Address - Fax:626-448-0438
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84127207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G841270Medicaid
CA00G841270Medicaid
CAG62500Medicare UPIN