Provider Demographics
NPI:1184824955
Name:DIXON, KIMBERLY DANITA (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DANITA
Last Name:DIXON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 34TH ST STE 100&200
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-2305
Mailing Address - Country:US
Mailing Address - Phone:833-678-2781
Mailing Address - Fax:661-368-0618
Practice Address - Street 1:625 34TH ST STE 100&200
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2305
Practice Address - Country:US
Practice Address - Phone:833-678-2781
Practice Address - Fax:661-368-0618
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13770208000000X
CAA115516208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVLL1797OtherNV MEDICAL LIC
CAA115516OtherCALIFORNIA LICENSE NUMBER