Provider Demographics
NPI:1548322688
Name:JONES, KATHLEEN KAY (MD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:KAY
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:KAY
Other - Last Name:ANDING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:18092 WIKA RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2132
Mailing Address - Country:US
Mailing Address - Phone:760-946-1415
Mailing Address - Fax:760-946-1446
Practice Address - Street 1:18092 WIKA RD
Practice Address - Street 2:SUITE 120
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2132
Practice Address - Country:US
Practice Address - Phone:760-946-1415
Practice Address - Fax:760-946-1446
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37766207Y00000X
IA21058207Y00000X
WI23744207Y00000X
TXG7635207Y00000X
OH35.044245207Y00000X
IL036-061861207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A377660Medicaid
CAB22104Medicare UPIN
CA00A377660Medicare ID - Type Unspecified