MEDICARE: MS. KIMBERLY DAWN KASPEREK P.A.

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	363A00000X	Physician Assistant	PA23111	CA

General Provider Information

NPI Number	:	1679905822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLY DAWN KASPEREK P.A.

Provider Business Mailing Address
First Line	:	3711 LONG BEACH BLVD STE 700
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3353
Country	:	US
Telephone Number	:	562-424-8422
Fax Number	:

Provider Business Practice Location Address
First Line	:	3711 LONG BEACH BLVD STE 700
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3353
Country	:	US
Telephone Number	:	562-424-8422
Fax Number	:

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

Provider Enumeration Date	:	07/30/2013
Last Update Date	:	11/29/2021

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