Physician Compare National (NPI:1922176551)

HEALTHCARE PROVIDER: KIM ANN CORNISH PH.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1922176551
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8628382504
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20150805009236
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	CORNISH
	Individual professional last name
Provider First Name	KIM
	Individual professional first name
Provider Middle Name	A
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2001
	Individual professional's medical school graduation year
Primary Specialty	PSYCHOLOGIST, CLINICAL
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	9075 ELK GR BLVD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 230
	Group Practice or individual's line 2 address
City	ELK GROVE
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	956243300
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5305141066
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y