Provider Demographics
NPI:1417217910
Name:RAPPAPORT, KIM
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:
Last Name:RAPPAPORT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22034 CLEARWOOD CT
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-1102
Mailing Address - Country:US
Mailing Address - Phone:408-873-8684
Mailing Address - Fax:
Practice Address - Street 1:855 EL CAMINO REAL STE 95
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2341
Practice Address - Country:US
Practice Address - Phone:650-327-6122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-18
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83381174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist