Provider Demographics
NPI:1942704341
Name:ANDERSON, KEMP MCTIER (MD)
Entity Type:Individual
Prefix:DR
First Name:KEMP
Middle Name:MCTIER
Last Name:ANDERSON
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 1:1520 SAN PABLO ST STE 4300
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-5330
Mailing Address - Country:US
Mailing Address - Phone:323-442-9064
Mailing Address - Fax:
Practice Address - Street 1:1520 SAN PABLO ST STE 4300
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5330
Practice Address - Country:US
Practice Address - Phone:323-442-9064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA164982208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery