Provider Demographics
NPI:1164500369
Name:HENRY, KIMBERLY ANNE (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANNE
Last Name:HENRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:350 BON AIR RD STE 1
Mailing Address - Street 2:STE 1
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1753
Mailing Address - Country:US
Mailing Address - Phone:415-924-1313
Mailing Address - Fax:415-925-1957
Practice Address - Street 1:350 BON AIR RD STE 1
Practice Address - Street 2:STE 1
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-1753
Practice Address - Country:US
Practice Address - Phone:415-924-1313
Practice Address - Fax:415-925-1957
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG74346208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C91834Medicare UPIN