Healthcare Provider Details

I. General information

NPI: 1629247358
Provider Name (Legal Business Name): CHAD BRIGHAM KIMBALL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 QUAIL SUMMIT DR
PROVO UT
84604
US

IV. Provider business mailing address

1145 QUAIL SUMMIT DR
PROVO UT
84604-5277
US

V. Phone/Fax

Practice location:
  • Phone: 801-556-2289
  • Fax: 801-691-0969
Mailing address:
  • Phone: 801-556-2289
  • Fax: 801-691-0969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number68514421205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number68514421205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: