1477793719 NPI number — MISS KIMBERLY ANN NEUMANN LAC, DIPLOM

Table of content: MISS KIMBERLY ANN NEUMANN LAC, DIPLOM (NPI 1477793719)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477793719 NPI number — MISS KIMBERLY ANN NEUMANN LAC, DIPLOM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEUMANN
Provider First Name:
KIMBERLY
Provider Middle Name:
ANN
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LAC, DIPLOM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477793719
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
691 28TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94121-2816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-225-1427
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4315 PIEDMONT AVE
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94611-4776
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-485-9355
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/26/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  12886 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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