Healthcare Provider Details

I. General information

NPI: 1386263192
Provider Name (Legal Business Name): KIMBERLY KAWANA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2020
Last Update Date: 04/11/2020
Certification Date: 04/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9550 HAGEMAN RD
BAKERSFIELD CA
93312-3956
US

IV. Provider business mailing address

3560 SERENA AVE
CLOVIS CA
93619-2020
US

V. Phone/Fax

Practice location:
  • Phone: 661-587-0838
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number81739
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: