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General NPI Number Information
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NPI Number | 1083425193
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Entity Type | Individual
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Provider Name | KIMBERLY DEAN CNA, CHHA
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Gender | Female
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Dates
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Enumeration Date | 01/17/2025
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Last Update Date | 01/17/2025
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Provider Practice Location Address
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Address Line | 10880 WILSHIRE BLVD STE 1101-29
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City | LOS ANGELES
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State | CA
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Zip | 90024-4101
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Country | US
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Telephone | 323-944-1332
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Fax |
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Provider Business Mailing Address
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Address Line | 3671 S WESTERN AVE APT 305
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City | LOS ANGELES
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State | CA
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Zip | 90018-3888
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Country | US
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Telephone | 323-944-1332
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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 | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | 00221605
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License Number State | CA
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