Provider Demographics
NPI:1376967869
Name:KIMZEY, KAREN (DDS)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:KIMZEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:DOAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1910 CUSTOMER CARE WAY
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301-5167
Mailing Address - Country:US
Mailing Address - Phone:209-384-6488
Mailing Address - Fax:
Practice Address - Street 1:1920 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-1827
Practice Address - Country:US
Practice Address - Phone:209-541-3001
Practice Address - Fax:209-538-1096
Is Sole Proprietor?:No
Enumeration Date:2014-02-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA635121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program