Healthcare Provider Details

I. General information

NPI: 1649432105
Provider Name (Legal Business Name): KIMBERLY ANN PAYTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

679 S NEW HAMPSHIRE AVE FL 4
LOS ANGELES CA
90005-1355
US

IV. Provider business mailing address

679 S NEW HAMPSHIRE AVE STE 400
LOS ANGELES CA
90005-1355
US

V. Phone/Fax

Practice location:
  • Phone: 213-639-0269
  • Fax: 213-365-2813
Mailing address:
  • Phone: 213-639-2500
  • Fax: 213-389-7358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: