MEDICARE: KENDELL ANN SIMM PA

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	PA1467	ID
2	363A00000X	Physician Assistant	PA12083	CA

General Provider Information

NPI Number	:	1811936545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDELL ANN SIMM PA

Provider Business Mailing Address
First Line	:	301 CEDAR ST.
Second Line	:	SUITE 206
City	:	SANDPOINT
State	:	ID
Zip	:	83864
Country	:	US
Telephone Number	:	949-923-3277
Fax Number	:	855-812-5865

Provider Business Practice Location Address
First Line	:	1198 PACIFIC COAST HWY
Second Line	:	SUITE I
City	:	SEAL BEACH
State	:	CA
Zip	:	90740-6251
Country	:	US
Telephone Number	:	562-799-7071
Fax Number	:	562-594-5627

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	03/17/2026

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Directions to “ KENDELL ANN SIMM PA” Practice Location

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