Provider Demographics
NPI:1588771331
Name:KAUFMAN, KIMBALL CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:KIMBALL
Middle Name:CHARLES
Last Name:KAUFMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 4TH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-5716
Mailing Address - Country:US
Mailing Address - Phone:415-457-5599
Mailing Address - Fax:415-457-5363
Practice Address - Street 1:411 4TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-5716
Practice Address - Country:US
Practice Address - Phone:415-457-5599
Practice Address - Fax:415-457-5363
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADM 318111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice