Provider Demographics
NPI:1225634116
Name:FARKAS, KIM MARIE
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:MARIE
Last Name:FARKAS
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 1:9737 E INVERNESS AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-7068
Mailing Address - Country:US
Mailing Address - Phone:480-789-1421
Mailing Address - Fax:602-585-0688
Practice Address - Street 1:1426 N MARVIN ST STE 101
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-2566
Practice Address - Country:US
Practice Address - Phone:480-356-7517
Practice Address - Fax:602-585-0688
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ009012227900000X
AZ1822156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist
No227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered