Provider Demographics
NPI:1316341142
Name:DAHM, KIMBERLY S (PA-C)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:DAHM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3841 PIPER ST
Mailing Address - Street 2:SUITE T377
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4624
Mailing Address - Country:US
Mailing Address - Phone:907-375-2000
Mailing Address - Fax:907-375-5558
Practice Address - Street 1:3841 PIPER ST
Practice Address - Street 2:SUITE T377
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4624
Practice Address - Country:US
Practice Address - Phone:907-375-2000
Practice Address - Fax:907-375-5558
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-22
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK2358363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical