MEDICARE: KIMBERLY M NOWAK DO, A PROFESSIONAL CORP

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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1144822602
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIMBERLY M NOWAK DO, A PROFESSIONAL CORP

Provider Business Mailing Address
First Line	:	2135 PARK DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-1919
Country	:	US
Telephone Number	:	714-318-3017
Fax Number	:

Provider Business Practice Location Address
First Line	:	2135 PARK DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-1919
Country	:	US
Telephone Number	:	714-318-3017
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KIMBERLY NOWAK
Credential	:	DO
Telephone Number	:	714-318-3017

Provider Enumeration Date	:	11/10/2020
Last Update Date	:	11/10/2020

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