MEDICARE: KIMBERLY L NEWELL GREEN MD

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	208000000X	Pediatrics Physician	A80595	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952489593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY L NEWELL GREEN MD

Provider Business Mailing Address
First Line	:	530 DIVISADERO ST STE 108
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94117-2213
Country	:	US
Telephone Number	:	415-725-5422
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 DIVISADERO ST STE 108
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94117-2213
Country	:	US
Telephone Number	:	415-725-5422
Fax Number	:

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	08/09/2024

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Directions to “ KIMBERLY L NEWELL GREEN MD” Practice Location

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