Healthcare Provider Details

I. General information

NPI: 1124246798
Provider Name (Legal Business Name): KUM IM WELLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N R ST
LOMPOC CA
93436-5226
US

IV. Provider business mailing address

300 N SAN ANTONIO RD
SANTA BARBARA CA
93110-1316
US

V. Phone/Fax

Practice location:
  • Phone: 805-737-6473
  • Fax:
Mailing address:
  • Phone: 805-681-5461
  • Fax: 805-681-5200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number589955
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: