Provider Demographics
NPI:1063508992
Name:SCHOEN, KIM M (NP)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:M
Last Name:SCHOEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:784 REINA DEL MAR AVE
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-3154
Mailing Address - Country:US
Mailing Address - Phone:415-225-5292
Mailing Address - Fax:
Practice Address - Street 1:90 VAN NESS AVE
Practice Address - Street 2:CENTRAL CITY OLDER ADULT MENTAL HEALTH CONSULTATION
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-6013
Practice Address - Country:US
Practice Address - Phone:415-558-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11315363LA2200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health