Provider Demographics
NPI:1902873805
Name:JONES, MARY KATHLEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:KATHLEEN
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:M
Other - Middle Name:KATHLEEN
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:301 W HUNTINGTON DR
Mailing Address - Street 2:SUITE 607
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-3462
Mailing Address - Country:US
Mailing Address - Phone:626-446-6134
Mailing Address - Fax:626-446-5807
Practice Address - Street 1:301 W HUNTINGTON DR
Practice Address - Street 2:SUITE 607
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-3462
Practice Address - Country:US
Practice Address - Phone:626-446-6134
Practice Address - Fax:626-446-5807
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC41135207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C411350Medicaid
CAW481Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
CAA37531Medicare UPIN