MEDICARE: DR. LEIGH S. KIMBERG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083P0901X	Public Health & General Preventive Medicine Physician	G76137	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	020651	OTHER		SFGH INTERNAL USE ONLY-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1093847022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEIGH S. KIMBERG MD

Provider Business Mailing Address
First Line	:	1301 PIERCE ST
Second Line	:	MAXINE HALL HEALTH CENTER
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-4005
Country	:	US
Telephone Number	:	415-292-1300
Fax Number	:	415-928-6487

Provider Business Practice Location Address
First Line	:	1301 PIERCE ST
Second Line	:	MAXINE HALL HEALTH CENTER
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-4005
Country	:	US
Telephone Number	:	415-292-1300
Fax Number	:	415-928-6487

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	07/08/2007

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