Provider Demographics
NPI:1023569555
Name:KEIM, KIMBERLY DAWN (NP)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:DAWN
Last Name:KEIM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7004 RAMSGATE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-2218
Mailing Address - Country:US
Mailing Address - Phone:713-446-5865
Mailing Address - Fax:310-374-4448
Practice Address - Street 1:555 PIER AVE
Practice Address - Street 2:SUITE E
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-3839
Practice Address - Country:US
Practice Address - Phone:310-374-6600
Practice Address - Fax:310-374-4448
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAF0815757363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily