Provider Demographics
NPI:1255512430
Name:KEMP, JUDITH ANNETTE (DO)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ANNETTE
Last Name:KEMP
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11347 MCBURNEY RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-2940
Mailing Address - Country:US
Mailing Address - Phone:858-245-2855
Mailing Address - Fax:858-566-4383
Practice Address - Street 1:11347 MCBURNEY RIDGE LN
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-2940
Practice Address - Country:US
Practice Address - Phone:858-245-2855
Practice Address - Fax:858-566-4383
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6980207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH21055Medicare UPIN