Healthcare Provider Details

I. General information

NPI: 1821484825
Provider Name (Legal Business Name): TARYN KILMER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2015
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 SCRABBLETOWN RD
ENCINO CA
91316-2865
US

IV. Provider business mailing address

426F SCRABBLETOWN RD
SANTA MONICA CA
90405-5452
US

V. Phone/Fax

Practice location:
  • Phone: 818-788-7840
  • Fax:
Mailing address:
  • Phone: 916-761-6118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA146798
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: