Provider Demographics
NPI:1699439844
Name:GILMORE, KIMBERLY (LAC, DAOM)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:GILMORE
Suffix:
Gender:F
Credentials:LAC, DAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8726 S SEPULVEDA BLVD # D1611
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-4014
Mailing Address - Country:US
Mailing Address - Phone:773-771-4713
Mailing Address - Fax:
Practice Address - Street 1:8726 S SEPULVEDA BLVD # D1611
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-4014
Practice Address - Country:US
Practice Address - Phone:773-771-4713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC19192171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist