Healthcare Provider Details

I. General information

NPI: 1366580474
Provider Name (Legal Business Name): DAVID MORRISON KIMZEY C.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 10/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5603 W HILLSDALE AVE
VISALIA CA
93291-5136
US

IV. Provider business mailing address

15163 OAK RANCH DR
VISALIA CA
93292-9373
US

V. Phone/Fax

Practice location:
  • Phone: 559-733-7976
  • Fax: 559-733-3836
Mailing address:
  • Phone: 559-300-4274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCO003478
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: