Provider Demographics
NPI:1205135878
Name:JAMES T LONDON M D A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:JAMES T LONDON M D A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:LONDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-833-2406
Mailing Address - Street 1:1360 W 6TH ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-3569
Mailing Address - Country:US
Mailing Address - Phone:310-833-2406
Mailing Address - Fax:310-519-8936
Practice Address - Street 1:1360 W 6TH ST
Practice Address - Street 2:SUITE 305
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-3569
Practice Address - Country:US
Practice Address - Phone:310-833-2406
Practice Address - Fax:310-519-8936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-22
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA23448OtherTYPE I NPI : 1366500647
CAA23448OtherTYPE I NPI : 1366500647