Basic Information
| Provider Information | |||||||||
| NPI: | 1013955186 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOTT | ||||||||
| FirstName: | KERRY | ||||||||
| MiddleName: | NORMAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9389 | ||||||||
| Address2: | |||||||||
| City: | ALTA LOMA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917018389 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9092685645 | ||||||||
| FaxNumber: | 9094500357 | ||||||||
| Practice Location | |||||||||
| Address1: | 255 E BONITA AVE | ||||||||
| Address2: | |||||||||
| City: | POMONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917671923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095967733 | ||||||||
| FaxNumber: | 9094500357 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 02/20/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 02/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | G65566 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | BK903Z | 01 | MEDICARE NO CAL PTAN | OTHER | G65566 | 01 | CA | CA LICENSE # | OTHER | 00C655660 | 05 | CA | MEDICAID | BG1839654 | 01 | CA | DEA CERT # | OTHER | GR0059670 | 05 | CA | MEDICAID |