Provider Demographics
NPI:1083637755
Name:THOMAS, KIM MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:MARIE
Last Name:THOMAS
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Gender:F
Credentials:DO
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Mailing Address - Street 1:11370 ANDERSON ST
Mailing Address - Street 2:SUITE 3615
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3450
Mailing Address - Country:US
Mailing Address - Phone:909-558-2481
Mailing Address - Fax:909-558-2608
Practice Address - Street 1:32395 CLINTON KEITH RD
Practice Address - Street 2:SUITE 104
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-7568
Practice Address - Country:US
Practice Address - Phone:951-678-9063
Practice Address - Fax:951-678-2893
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2009-07-21
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Provider Licenses
StateLicense IDTaxonomies
CA20A7074207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG65432Medicare UPIN