Provider Demographics
NPI:1073513925
Name:EDDINGS-REECE, KIMBERLY JILL (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JILL
Last Name:EDDINGS-REECE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:JILL
Other - Last Name:REECE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1234
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90714-1234
Mailing Address - Country:US
Mailing Address - Phone:310-316-0811
Mailing Address - Fax:
Practice Address - Street 1:1045 W REDONDO BEACH BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4128
Practice Address - Country:US
Practice Address - Phone:310-225-2825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80753207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G807530OtherMEDI CAL
CA00G807530OtherMEDI CAL