Provider Demographics
NPI:1215140629
Name:LUDLOW, KIMBERLEY (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:
Last Name:LUDLOW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 ALONDRA BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-4000
Mailing Address - Country:US
Mailing Address - Phone:562-531-8300
Mailing Address - Fax:562-531-8035
Practice Address - Street 1:5203 LAKEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2415
Practice Address - Country:US
Practice Address - Phone:562-633-2273
Practice Address - Fax:562-633-1796
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40146174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty