Healthcare Provider Details

I. General information

NPI: 1689744377
Provider Name (Legal Business Name): KIMBERLY M IMAJO AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7275 GLEN FOREST DRIVE SUITE 208
RICHMOND VA
23226
US

IV. Provider business mailing address

7275 GLEN FOREST DRIVE SUITE 208
RICHMOND VA
23226
US

V. Phone/Fax

Practice location:
  • Phone: 804-282-0022
  • Fax: 804-282-2441
Mailing address:
  • Phone: 804-282-0022
  • Fax: 804-282-2441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2101001343
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2201001143
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: