Provider Demographics
NPI:1164706248
Name:KODIMER, WAH-MEI
Entity Type:Individual
Prefix:
First Name:WAH-MEI
Middle Name:
Last Name:KODIMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2435
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92593-2435
Mailing Address - Country:US
Mailing Address - Phone:951-676-4393
Mailing Address - Fax:951-694-0553
Practice Address - Street 1:27720 JEFFERSON AVE
Practice Address - Street 2:STE 101
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-2610
Practice Address - Country:US
Practice Address - Phone:951-676-4393
Practice Address - Fax:951-694-0553
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program