MEDICARE: DR. KIMBERLY ANN CHARLTON M.D.

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	2084P0800X	Psychiatry Physician	DR.0051678	CO
2	2084P0800X	Psychiatry Physician	MD11530	HI
3	2084P0804X	Child & Adolescent Psychiatry Physician	DR.0051678	CO
4	2084P0800X	Psychiatry Physician	G88843	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A0232304	OTHER	HI	HMSA-QUEST
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MD11530	OTHER	HI	MDX HAWAII
4	990298651-96706-E049	OTHER	HI	TRICARE
5	961761	OTHER	HI	UNIVERSITY HEALTH ALLIANC
6	00A0232304	OTHER	HI	HMSA
7	1236	OTHER	HI	ALOHACARE
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447317771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY ANN CHARLTON M.D.

Provider Business Mailing Address
First Line	:	6255 W SUNSET BLVD FL 21
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-7422
Country	:	US
Telephone Number	:	323-498-6674
Fax Number	:	855-312-7678

Provider Business Practice Location Address
First Line	:	1400 S GRAND AVE STE 801
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-3068
Country	:	US
Telephone Number	:	213-741-9727
Fax Number	:	213-741-0867

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

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	10/30/2019

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Directions to “ DR. KIMBERLY ANN CHARLTON M.D.” Practice Location

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