Healthcare Provider Details

I. General information

NPI: 1205170446
Provider Name (Legal Business Name): KIMBERLY ROBIN SMITH L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2012
Last Update Date: 11/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

485 LOS COCHES ST
MILPITAS CA
95035-5422
US

IV. Provider business mailing address

2583 PANTALIS DR
SAN JOSE CA
95132-2638
US

V. Phone/Fax

Practice location:
  • Phone: 408-946-9332
  • Fax:
Mailing address:
  • Phone: 408-929-4678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC1329
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: