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General NPI Number Information
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NPI Number | 1114491743
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Entity Type | Organization
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Legal Business Name | KIMBERLY HICKS M D INC
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Dates
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Enumeration Date | 01/16/2019
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Last Update Date | 01/16/2019
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Provider Practice Location Address
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Address Line | 3317 ELM ST STE 102
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City | OAKLAND
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State | CA
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Zip | 94609-3053
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Country | US
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Telephone | 510-595-9880
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Fax | 510-595-9881
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Provider Business Mailing Address
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Address Line | 3317 ELM ST STE 102
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City | OAKLAND
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State | CA
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Zip | 94609-3053
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Country | US
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Telephone | 510-595-9880
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Fax | 510-517-8001
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Authorized Official
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Title or Position | CEO
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Name | KIMBERLY HICKS
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Credential | MD
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Telephone | 510-517-8005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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