Healthcare Provider Details

I. General information

NPI: 1538725973
Provider Name (Legal Business Name): KIMBERLY SUE KAHLER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2019
Last Update Date: 05/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19969 GREENLEY RD STE C
SONORA CA
95370-5908
US

IV. Provider business mailing address

1311 SANGUINETTI RD
SONORA CA
95370-6210
US

V. Phone/Fax

Practice location:
  • Phone: 209-928-5400
  • Fax: 209-928-5414
Mailing address:
  • Phone: 209-928-5400
  • Fax: 209-928-5414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberRDH13555
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: