Healthcare Provider Details

I. General information

NPI: 1376705111
Provider Name (Legal Business Name): KIMBERLY KINDER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 MISSION RANCH BLVD STE 100
CHICO CA
95926-2175
US

IV. Provider business mailing address

1967 LAWRENCE ST
KLAMATH FALLS OR
97601
US

V. Phone/Fax

Practice location:
  • Phone: 530-342-2411
  • Fax: 530-894-5783
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA142311
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: