1508830944 NPI number — DR. BONNIE S KIMMEL M.D.

Table of content: DR. BONNIE S KIMMEL M.D. (NPI 1508830944)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508830944 NPI number — DR. BONNIE S KIMMEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIMMEL
Provider First Name:
BONNIE
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1508830944
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DEPT 34929
Provider Second Line Business Mailing Address:
P.O. BOX 39000
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94139-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-952-2828
Provider Business Mailing Address Fax Number:
925-952-2850

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1450 TREAT BLVD
Provider Second Line Business Practice Location Address:
SUITE 250A
Provider Business Practice Location Address City Name:
WALNUT CREEK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94597-2168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-296-9740
Provider Business Practice Location Address Fax Number:
925-296-9062
Provider Enumeration Date:
02/14/2006

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: 207RE0101X , with the licence number:  A98500 , 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)

  • Identifier: P01288744 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 001431668 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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