Provider Demographics
NPI:1487670329
Name:DAVIS, KIM T (CNM)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:T
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8540 S SEPULVEDA BLVD
Mailing Address - Street 2:#1002
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3807
Mailing Address - Country:US
Mailing Address - Phone:310-670-2085
Mailing Address - Fax:310-670-8258
Practice Address - Street 1:8540 S SEPULVEDA BLVD STE 1002
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3808
Practice Address - Country:US
Practice Address - Phone:310-670-2085
Practice Address - Fax:310-670-8258
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANMW972OtherCALIF. NURSE MIDWIFE CERT