Provider Demographics
NPI:1104016310
Name:BROWN, KIMBERLY SUE (LAC ND)
Entity Type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:SUE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LAC ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 ROSS AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-3038
Mailing Address - Country:US
Mailing Address - Phone:408-357-3422
Mailing Address - Fax:
Practice Address - Street 1:3535 ROSS AVE STE 100
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-3038
Practice Address - Country:US
Practice Address - Phone:408-357-3422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA408175F00000X
CA14113171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No175F00000XOther Service ProvidersNaturopath