Healthcare Provider Details

I. General information

NPI: 1457374076
Provider Name (Legal Business Name): DOUGLAS WAYNE KINDALL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 MEISTER WAY
SACRAMENTO CA
95819-1921
US

IV. Provider business mailing address

PO BOX 19133
SACRAMENTO CA
95819-0133
US

V. Phone/Fax

Practice location:
  • Phone: 916-329-9210
  • Fax: 916-329-9218
Mailing address:
  • Phone: 916-329-9210
  • Fax: 916-329-9218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberG60717
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: