MEDICARE: DR. KIMBERLY ANN CALDWELL DDS

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	122300000X	Dentist	61470	CA

General Provider Information

NPI Number	:	1154471266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY ANN CALDWELL DDS

Provider Business Mailing Address
First Line	:	918 S ROBERTSON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-1611
Country	:	US
Telephone Number	:	424-280-9662
Fax Number	:

Provider Business Practice Location Address
First Line	:	918 S ROBERTSON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-1611
Country	:	US
Telephone Number	:	424-280-9662
Fax Number	:

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

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	01/14/2014

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