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General NPI Number Information
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NPI Number | 1629247358
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Entity Type | Individual
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Provider Name | CHAD BRIGHAM KIMBALL M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/27/2008
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Last Update Date | 06/25/2019
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Provider Practice Location Address
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Address Line | 1145 QUAIL SUMMIT DR
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City | PROVO
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State | UT
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Zip | 84604
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Country | US
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Telephone | 801-556-2289
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Fax | 801-691-0969
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Provider Business Mailing Address
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Address Line | 1145 QUAIL SUMMIT DR
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City | PROVO
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State | UT
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Zip | 84604-5277
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Country | US
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Telephone | 801-556-2289
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Fax | 801-691-0969
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 68514421205
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | 68514421205
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License Number State | UT
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