Healthcare Provider Details

I. General information

NPI: 1124176300
Provider Name (Legal Business Name): KIMBERLY M KUHN DOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2007
Last Update Date: 03/04/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4163 1ST AVE S
ST PETERSBURG FL
33711-1101
US

IV. Provider business mailing address

4163 1ST AVE S
ST PETERSBURG FL
33711-1101
US

V. Phone/Fax

Practice location:
  • Phone: 727-710-4798
  • Fax: 831-621-4820
Mailing address:
  • Phone: 727-710-4798
  • Fax: 831-621-4820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904004696
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13138
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number27146
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP3850
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: