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General NPI Number Information
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NPI Number | 1588648653
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Entity Type | Individual
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Provider Name | MICHAEL PATTON KIMBALL M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/02/2005
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 9333 GENESEE AVE STE 350
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City | SAN DIEGO
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State | CA
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Zip | 92121-2103
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Country | US
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Telephone | 858-455-6460
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Fax | 858-455-7197
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Provider Business Mailing Address
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Address Line | 9333 GENESEE AVE STE 350
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City | SAN DIEGO
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State | CA
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Zip | 92121-2103
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Country | US
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Telephone | 858-455-6460
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Fax | 858-455-7197
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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 | 207XP3100X
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Taxonomy Name | Pediatric Orthopaedic Surgery Physician
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License Number | G76060
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License Number State | CA
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