Provider Demographics
NPI:1487274528
Name:KIMBELL, YUVAL ZEV (PA-C)
Entity type:Individual
Prefix:
First Name:YUVAL
Middle Name:ZEV
Last Name:KIMBELL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:YUVAL
Other - Middle Name:
Other - Last Name:KIMBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2216 E NC HIGHWAY 54
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-2208
Mailing Address - Country:US
Mailing Address - Phone:919-235-1040
Mailing Address - Fax:919-341-3045
Practice Address - Street 1:2216 E NC HIGHWAY 54
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-2208
Practice Address - Country:US
Practice Address - Phone:919-235-1040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-18
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-10946363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1487274528Medicaid