Provider Demographics
NPI:1962150839
Name:KIMSEY, RYAN (NP)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:KIMSEY
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-2511
Mailing Address - Country:US
Mailing Address - Phone:415-463-0767
Mailing Address - Fax:
Practice Address - Street 1:3 S LINDEN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-6407
Practice Address - Country:US
Practice Address - Phone:650-238-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95020238372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion