Basic Information
| Provider Information | |||||||||
| NPI: | 1619055696 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EDMUNDS | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | SHANNON | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2138 MALCOLM AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900256306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105970736 | ||||||||
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| Practice Location | |||||||||
| Address1: | 111 N SEPULVEDA BLVD | ||||||||
| Address2: | STE. 210 | ||||||||
| City: | MANHATTAN BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902666861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103792134 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 02/05/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD2005-0177 | NM | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | A101151 | CA | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.