MEDICARE: DR. VIRGINIA E KIMONIS MD

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207SG0201X	Clinical Genetics (M.D.) Physician	156969	MA
2	207SG0202X	Clinical Biochemical Genetics Physician	156969	MA
3	208000000X	Pediatrics Physician	156969	MA
4	207SG0201X	Clinical Genetics (M.D.) Physician	C52311	CA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1912964925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIRGINIA E KIMONIS MD

Provider Business Mailing Address
First Line	:	200 S MANCHESTER AVE STE 300
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92868-3219
Country	:	US
Telephone Number	:	714-456-2986
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 THE CITY DR S # ZC4482
Second Line	:	DIVISION OF GENETICS AND METABOLISM
City	:	ORANGE
State	:	CA
Zip	:	92868-3201
Country	:	US
Telephone Number	:	714-456-5792
Fax Number	:	714-456-5330

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	02/28/2023

3 SAINT STEPHENS PL , SUITE 2
WARWICK, NY
10990-3208

Practice Phone: 845-987-9700
Practice Fax: