Provider Demographics
NPI:1104254887
Name:LEW, KIMBERLY (ATC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:LEW
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 BELHAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-4208
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2227 PIEDMONT AVE
Practice Address - Street 2:SIMPSON CENTER, RM. 170
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94720-2325
Practice Address - Country:US
Practice Address - Phone:510-642-4878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer