Provider Demographics
NPI:1417217910
Name:RAPPORT, KIM
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:
Last Name:RAPPORT
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 1:22034 CLEARWOOD CT
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-1102
Mailing Address - Country:US
Mailing Address - Phone:408-873-8684
Mailing Address - Fax:
Practice Address - Street 1:2255 S BASCOM AVE STE 200
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-7800
Practice Address - Country:US
Practice Address - Phone:408-376-3626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83381174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist