Healthcare Provider Details

I. General information

NPI: 1407173040
Provider Name (Legal Business Name): KIMBERLY ANN CUMMINGS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2010
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2935 SW CEDAR HILLS BLVD
BEAVERTON OR
97005-1342
US

IV. Provider business mailing address

2935 SW CEDAR HILLS BLVD
BEAVERTON OR
97005-1342
US

V. Phone/Fax

Practice location:
  • Phone: 503-352-6000
  • Fax: 503-352-6080
Mailing address:
  • Phone: 503-352-6000
  • Fax: 503-352-6080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD163817
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: