Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | G156209 | CA |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | G156209 | CA |
NPI | 1447244868 |
---|---|
Provider Name | David M Kimble |
First Address | Torrance, CA 90510-3129 |
Second Address | Pasadena, CA 91105-2606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2005 |
Last Update Date | 21/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G31481 | (02) | NY |