Provider Demographics
NPI:1336205731
Name:HIMSL, KYLE KENNYSTON (MD)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:KENNYSTON
Last Name:HIMSL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:415 ROLLING OAKS DR
Mailing Address - Street 2:SUITE 260
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1029
Mailing Address - Country:US
Mailing Address - Phone:805-371-4707
Mailing Address - Fax:
Practice Address - Street 1:415 ROLLING OAKS DR
Practice Address - Street 2:SUITE 260
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1029
Practice Address - Country:US
Practice Address - Phone:805-371-4707
Practice Address - Fax:805-371-4714
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG60233208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G60233Medicaid
F02833Medicare UPIN
F02833Medicare UPIN