Healthcare Provider Details

I. General information

NPI: 1275876088
Provider Name (Legal Business Name): KIMBERLY JABLON SKINNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY JABLON MD

II. Dates (important events)

Enumeration Date: 03/29/2013
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE BOX 0110
SAN FRANCISCO CA
94143-0110
US

IV. Provider business mailing address

1255 16TH AVE APT 2
SAN FRANCISCO CA
94122-2035
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-6245
  • Fax:
Mailing address:
  • Phone: 919-259-3289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA137161
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: