Provider Demographics
NPI:1396325460
Name:KIMANI, MAUREEN (MD)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:KIMANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12005 MERIDIAN E STE 101
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-3423
Mailing Address - Country:US
Mailing Address - Phone:253-841-6100
Mailing Address - Fax:253-841-6139
Practice Address - Street 1:12005 MERIDIAN E STE 101
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3423
Practice Address - Country:US
Practice Address - Phone:253-841-6100
Practice Address - Fax:253-841-6139
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD61466519207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2180453Medicaid