Healthcare Provider Details

I. General information

NPI: 1609167634
Provider Name (Legal Business Name): MR. MICHAEL KIMBERLING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2011
Last Update Date: 01/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HARBOR BLVD
BELMONT CA
94002-4018
US

IV. Provider business mailing address

435 E OKEEFE ST #70
EAST PALO ALTO CA
94303-5119
US

V. Phone/Fax

Practice location:
  • Phone: 650-817-9070
  • Fax: 650-246-3838
Mailing address:
  • Phone: 650-817-9070
  • Fax: 650-246-3838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: