Healthcare Provider Details

I. General information

NPI: 1598991176
Provider Name (Legal Business Name): KIMBERLY ANN GAITHER RDHAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 10/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3717 S LA BREA AVE #520
LOS ANGELES CA
90016-5300
US

IV. Provider business mailing address

3717 S LA BREA AVE #520
LOS ANGELES CA
90016-5300
US

V. Phone/Fax

Practice location:
  • Phone: 310-776-0055
  • Fax: 310-671-1089
Mailing address:
  • Phone: 310-776-0055
  • Fax: 310-671-1089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number260
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: