Healthcare Provider Details

I. General information

NPI: 1679188304
Provider Name (Legal Business Name): KIMBERLY YAM FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 BALDWIN PARK BLVD
BALDWIN PARK CA
91706-5806
US

IV. Provider business mailing address

2238 N SAN ANTONIO AVE
POMONA CA
91767-2406
US

V. Phone/Fax

Practice location:
  • Phone: 833-574-2273
  • Fax:
Mailing address:
  • Phone: 626-523-6465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95014927
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: