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General NPI Number Information
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NPI Number | 1083895395
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Entity Type | Individual
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Provider Name | KIMMY GOYAL M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/15/2007
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Last Update Date | 11/15/2007
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Provider Practice Location Address
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Address Line | 4879 US ROUTE 68 SOUTH
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City | WEST LIBERTY
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State | OH
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Zip | 43357
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Country | US
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Telephone | 937-465-0080
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Fax |
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Provider Business Mailing Address
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Address Line | 427 KENT DR APT 6
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City | BELLEFONTAINE
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State | OH
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Zip | 43311-9054
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Country | US
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Telephone | 937-539-2216
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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 | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 57-013906
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License Number State | OH
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