Healthcare Provider Details

I. General information

NPI: 1366360497
Provider Name (Legal Business Name): YVONNE KIMAZI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4210 N ALESTER AVE
MERIDIAN ID
83646-6863
US

IV. Provider business mailing address

4210 N ALESTER AVE
MERIDIAN ID
83646-6863
US

V. Phone/Fax

Practice location:
  • Phone: 208-392-0195
  • Fax:
Mailing address:
  • Phone: 208-392-0195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: