Provider Demographics
NPI:1801233945
Name:KOLE, JONATHAN WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:WILLIAM
Last Name:KOLE
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 1:2417 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-4009
Mailing Address - Country:US
Mailing Address - Phone:855-446-4374
Mailing Address - Fax:415-520-6405
Practice Address - Street 1:2417 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-4009
Practice Address - Country:US
Practice Address - Phone:855-446-4374
Practice Address - Fax:415-520-6405
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-30
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20200131902084P0800X
RIMD159042084P0800X
CAA1696652084P0804X
RILP028382084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry