Healthcare Provider Details

I. General information

NPI: 1487670329
Provider Name (Legal Business Name): KIM T DAVIS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 11/30/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8540 S SEPULVEDA BLVD STE 1002
LOS ANGELES CA
90045-3808
US

IV. Provider business mailing address

8540 S SEPULVEDA BLVD #1002
LOS ANGELES CA
90045-3807
US

V. Phone/Fax

Practice location:
  • Phone: 310-670-2085
  • Fax: 310-670-8258
Mailing address:
  • Phone: 310-670-2085
  • Fax: 310-670-8258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: