Provider Demographics
NPI:1073338521
Name:BATES, ABBIE KIM (DNP)
Entity type:Individual
Prefix:DR
First Name:ABBIE
Middle Name:KIM
Last Name:BATES
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 W G ST UNIT 221
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-5953
Mailing Address - Country:US
Mailing Address - Phone:425-205-7675
Mailing Address - Fax:
Practice Address - Street 1:1401 N EL CAMINO REAL STE 100
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-4983
Practice Address - Country:US
Practice Address - Phone:858-522-0145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA950326442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry