Provider Demographics
NPI:1972500163
Name:KIMBALL, CHRISTINA EVE JENSEN (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA EVE
Middle Name:JENSEN
Last Name:KIMBALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:C EVE
Other - Middle Name:J
Other - Last Name:KIMBALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:14 GAELSONG LN
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3120
Mailing Address - Country:US
Mailing Address - Phone:610-463-8775
Mailing Address - Fax:
Practice Address - Street 1:14 GAELSONG LN
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3120
Practice Address - Country:US
Practice Address - Phone:610-463-8775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044705E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD-044705EOtherMEDICAL LICENSE
PA101807512Medicaid
PA101807512Medicaid
PAE52511Medicare UPIN