MEDICARE: KIMBERLY GUNDERSON LMFT

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	106H00000X	Marriage & Family Therapist	MFC49439	CA

General Provider Information

NPI Number	:	1790536753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY GUNDERSON LMFT

Provider Business Mailing Address
First Line	:	PO BOX 583
Second Line	:
City	:	YORBA LINDA
State	:	CA
Zip	:	92885-0583
Country	:	US
Telephone Number	:	714-309-1604
Fax Number	:

Provider Business Practice Location Address
First Line	:	4811 EUREKA AVE STE G3
Second Line	:
City	:	YORBA LINDA
State	:	CA
Zip	:	92886-3312
Country	:	US
Telephone Number	:	714-309-1604
Fax Number	:

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

Provider Enumeration Date	:	03/28/2024
Last Update Date	:	01/30/2026

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