Kiddox Medical Group, Inc.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

G24539 Issued in CA

Legal business name

KIDDOX MEDICAL GROUP, INC.

Practice address

1245 16TH St
#305
Santa Monica, CA 90404-1235

Phone

(310) 453-9010

Fax

(310) 828-3661

NPI assigned

Feb 1, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jeffrey Philip Bourne, M.D.

Title

Secretary

Phone

(310) 453-9010

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1255479408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1245 16TH ST",
            "address_2": "#305",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904041235",
            "telephone_number": "310-453-9010",
            "fax_number": "310-828-3661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1245 16TH ST",
            "address_2": "#305",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904041235",
            "telephone_number": "310-453-9010",
            "fax_number": "310-828-3661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDDOX MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BOURNE",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "PHILIP",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "310-453-9010",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "G24539",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deven Khosla, M.D.
• Ashkan Khosravi
• Sanaz Khoubnazar, D.M.D.
• Khuyen Nguyen PC Dba the Gleamery
• Adam Jason Kidd, M.A.
• Tracey Kiernan
• Helen Kiger, RN
• Amy L Kijner, PA
• Jessica Rose Kilburn
• Lynn Kilroy, PH.D.

• Pediatrics Physician in Santa Monica, CA
• Providers in Santa Monica, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.