Provider Demographics
NPI:1699789792
Name:KIMBER, NANCY DIANE (MD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:DIANE
Last Name:KIMBER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3851 KATELLA AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3566
Mailing Address - Country:US
Mailing Address - Phone:562-430-0805
Mailing Address - Fax:562-430-0806
Practice Address - Street 1:3851 KATELLA AVE STE 300
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3566
Practice Address - Country:US
Practice Address - Phone:562-430-0805
Practice Address - Fax:562-430-0806
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65877207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH01888Medicare UPIN
CAW18301Medicare ID - Type UnspecifiedGROUP ID