Provider Demographics
NPI:1811922727
Name:KIDD, CHRISTIE KAY (PA C)
Entity type:Individual
Prefix:MS
First Name:CHRISTIE
Middle Name:KAY
Last Name:KIDD
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1140 MANHATTAN BEACH BLVD
Mailing Address - Street 2:UNIT H
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266
Mailing Address - Country:US
Mailing Address - Phone:310-545-9309
Mailing Address - Fax:
Practice Address - Street 1:433 N CAMDEN DR
Practice Address - Street 2:SUITE 805
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210
Practice Address - Country:US
Practice Address - Phone:310-550-7661
Practice Address - Fax:310-550-1920
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14436363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Not Answered363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S50424Medicare UPIN
WPA14436AMedicare ID - Type Unspecified