Healthcare Provider Details

I. General information

NPI: 1902937386
Provider Name (Legal Business Name): KIMBERLY ANN HAMILTON LAC, DNBAO, CIDE,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GENERAL DELIVERY 562 ANGWIN
SOMES BAR CA
95568-9999
US

IV. Provider business mailing address

POST OFFICE BOX 562 GENERAL DELIVERY
SOMES BAR CA
95568-9999
US

V. Phone/Fax

Practice location:
  • Phone: 707-965-2955
  • Fax:
Mailing address:
  • Phone: 707-965-2955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC3319
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: