Provider Demographics
NPI:1053919332
Name:KINGSLEY CLINIC OF CALIFORNIA, PC
Entity type:Organization
Organization Name:KINGSLEY CLINIC OF CALIFORNIA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:KINGSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-608-4001
Mailing Address - Street 1:33471 BILTMORE DR
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-1849
Mailing Address - Country:US
Mailing Address - Phone:530-305-7637
Mailing Address - Fax:
Practice Address - Street 1:275 E HILLCREST DR STE 160
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-7772
Practice Address - Country:US
Practice Address - Phone:530-305-7637
Practice Address - Fax:805-254-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-09
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty