MEDICARE: KAREN KIMZEY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	63512	CA
2	1223G0001X	General Practice Dentistry	63512	CA
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1376967869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN KIMZEY DDS

Provider Business Mailing Address
First Line	:	9309 OFFICE PARK CIR STE 100
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758-8072
Country	:	US
Telephone Number	:	916-423-3636
Fax Number	:

Provider Business Practice Location Address
First Line	:	9309 OFFICE PARK CIR STE 100
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758-8072
Country	:	US
Telephone Number	:	916-423-3616
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2014
Last Update Date	:	08/10/2025

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