Provider Demographics
NPI:1033117106
Name:FLORA, KIM DAVID (DPM)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:DAVID
Last Name:FLORA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:DAVID
Other - Last Name:FLORA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM, INC
Mailing Address - Street 1:1086 N CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-2251
Mailing Address - Country:US
Mailing Address - Phone:559-686-9459
Mailing Address - Fax:559-688-1814
Practice Address - Street 1:1086 N. CHERRY STREET
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-2251
Practice Address - Country:US
Practice Address - Phone:559-688-3668
Practice Address - Fax:559-688-1814
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3667213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E36670OtherMEDI-CAL ID #
CARHC140182OtherRADIOGRAPHY LIC #
CABF2371994OtherDEA LICENSE #
CAU01893Medicare UPIN
CA000E36670OtherMEDI-CAL ID #
CA1069300001Medicare NSC