Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | ||
Y | 103T00000X | Psychologist |
NPI | 1003018391 |
---|---|
Provider Name | Dr. Ronald C. Kimmons |
First Address | Oakland, CA 94601-1211 |
Second Address | Oakland, CA 94601-1211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2007 |
Last Update Date | 06/12/2010 |