Provider Demographics
NPI:1083425193
Name:DEAN, KIMBERLY (CNA, CHHA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:DEAN
Suffix:
Gender:F
Credentials:CNA, CHHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3671 S WESTERN AVE APT 305
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90018-3888
Mailing Address - Country:US
Mailing Address - Phone:323-944-1332
Mailing Address - Fax:
Practice Address - Street 1:10880 WILSHIRE BLVD STE 1101-29
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4101
Practice Address - Country:US
Practice Address - Phone:323-944-1332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00221605374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide