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General NPI Number Information
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NPI Number | 1548633399
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Entity Type | Organization
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Legal Business Name | KIM'S WELLNESS CENTER
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Dates
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Enumeration Date | 11/02/2015
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Last Update Date | 01/25/2017
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Provider Practice Location Address
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Address Line | 917 SW OAK ST
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City | PORTLAND
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State | OR
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Zip | 97205
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Country | US
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Telephone | 917-456-6385
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Fax | 844-401-8624
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Provider Business Mailing Address
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Address Line | 1011 NE HANCOCK ST
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City | PORTLAND
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State | OR
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Zip | 97212
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Country | US
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Telephone | 917-456-6385
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Fax | 844-401-8624
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Authorized Official
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Title or Position | OWNER
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Name | KIMBERLY BOLDRINI-SENN
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Credential | LAC
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Telephone | 917-456-6385
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 165166
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License Number State | OR
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