Healthcare Provider Details

I. General information

NPI: 1770572182
Provider Name (Legal Business Name): KIMAIW MED CNTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 01/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 AIRPORT ROAD
HOOPA CA
95546
US

IV. Provider business mailing address

2610 WALBERT AVE
ALLENTOWN PA
18104-1852
US

V. Phone/Fax

Practice location:
  • Phone: 530-625-4261
  • Fax: 530-625-4842
Mailing address:
  • Phone: 800-473-2278
  • Fax: 610-435-2278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number StateCA

VIII. Authorized Official

Name: EMMETT CHASE
Title or Position: CEO
Credential: MD
Phone: 530-625-4261