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NPI Code Detail

MEDICARE: RYAN SAMUEL KIMBALL PHD

MEDICARE: RYAN SAMUEL KIMBALL PHD
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
1103TC0700XClinical PsychologistPSY.0005901CO

General Provider Information

NPI Number : 1336863216
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN SAMUEL KIMBALL PHD
Provider Business Mailing Address
First Line : 21825 E QUINCY AVE
Second Line :
City : AURORA
State : CO
Zip : 80018-3155
Country : US
Telephone Number : 720-723-3593
Fax Number :
Provider Business Practice Location Address
First Line : 21825 E QUINCY AVE
Second Line :
City : AURORA
State : CO
Zip : 80018-3155
Country : US
Telephone Number : 720-723-3593
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2022
Last Update Date : 05/05/2026

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Directions to “ RYAN SAMUEL KIMBALL PHD” Practice Location

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