Healthcare Provider Details

I. General information

NPI: 1013097906
Provider Name (Legal Business Name): KIM HOROWITZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 05/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20797 SANTA LUCIA ST
TEHACHAPI CA
93561-8676
US

IV. Provider business mailing address

PO BOX 1898
TEHACHAPI CA
93581-1898
US

V. Phone/Fax

Practice location:
  • Phone: 661-822-9105
  • Fax: 661-822-6953
Mailing address:
  • Phone: 661-822-9105
  • Fax: 661-822-6953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA42396
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: