Basic Information
| Provider Information | |||||||||
| NPI: | 1134160666 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KINMAN | ||||||||
| FirstName: | RENEE | ||||||||
| MiddleName: | ANNETTE POULIN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2625 E DIVISADERO ST | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937211431 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 726 N MEDICAL CENTER DR E STE 209 | ||||||||
| Address2: | |||||||||
| City: | CLOVIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936116886 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5593255656 | ||||||||
| FaxNumber: | 5593255568 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 11/29/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A92381 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | A92381 | CA | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0205X | A92381 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology |
No ID Information.