Healthcare Provider Details

I. General information

NPI: 1104159334
Provider Name (Legal Business Name): LYNN MARIE KINMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2009
Last Update Date: 09/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2667 ENTERPRISE RD
RENO NV
89512-1666
US

IV. Provider business mailing address

13160 MUHLEBACH WAY
TRUCKEE CA
96161-6424
US

V. Phone/Fax

Practice location:
  • Phone: 775-688-1341
  • Fax: 775-688-2984
Mailing address:
  • Phone: 530-550-0654
  • Fax: 775-688-2984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number8117
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG069741
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: