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General NPI Number Information
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NPI Number | 1073303988
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Entity Type | Individual
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Provider Name | KIM WALKER
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Gender |
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Dates
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Enumeration Date | 05/12/2025
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 2570 48TH ST
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City | SACRAMENTO
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State | CA
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Zip | 95817-1541
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Country | US
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Telephone | 831-801-0792
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Fax |
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Provider Business Mailing Address
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Address Line | 1795 SUNNYSLOPE RD
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City | HOLLISTER
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State | CA
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Zip | 95023-6028
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 493618
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License Number State | CA
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