Healthcare Provider Details

I. General information

NPI: 1235116732
Provider Name (Legal Business Name): KIMBERLY A HARDIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 V ST STE 3400
SACRAMENTO CA
95817-1460
US

IV. Provider business mailing address

4150 V ST STE 3400
SACRAMENTO CA
95817-1460
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3564
  • Fax: 916-734-7924
Mailing address:
  • Phone: 916-734-3564
  • Fax: 916-734-7924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA60838
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA60838
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA60838
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberA60838
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: