Provider Demographics
NPI:1033509799
Name:TWILLING, KIM
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:TWILLING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11670 ATWOOD RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-9522
Mailing Address - Country:US
Mailing Address - Phone:916-216-4721
Mailing Address - Fax:
Practice Address - Street 1:11670 ATWOOD RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-9522
Practice Address - Country:US
Practice Address - Phone:530-887-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28337124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist