Basic Information
| Provider Information | |||||||||
| NPI: | 1376967869 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIMZEY | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | |||||||||
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| Credential: | DDS | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | DOAN | ||||||||
| OtherFirstName: | KAREN | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1910 CUSTOMER CARE WAY | ||||||||
| Address2: | |||||||||
| City: | ATWATER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953015167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093846488 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1920 MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | CERES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953071827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095413001 | ||||||||
| FaxNumber: | 2095381096 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2014 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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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 | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 1223G0001X | 63512 | CA | Y | Dental Providers | Dentist | General Practice |
No ID Information.