Provider Demographics
NPI:1306242292
Name:KITE, GREGORY RYAN (SF-IDC)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:RYAN
Last Name:KITE
Suffix:
Gender:M
Credentials:SF-IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 ADMIRAL TAUSSIG BLVD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23511-2802
Mailing Address - Country:US
Mailing Address - Phone:909-810-3878
Mailing Address - Fax:
Practice Address - Street 1:24323 JACKSON AVE APT 721
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-7905
Practice Address - Country:US
Practice Address - Phone:909-810-3878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-05
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1710I1002X
CA1710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman