Provider Demographics
NPI:1497789747
Name:CLYMAN, KATHERINE R (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:R
Last Name:CLYMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATHERINE
Other - Middle Name:S
Other - Last Name:FIELDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1800 HARRISON ST FL 7
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3466
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:877-738-4262
Practice Address - Street 1:7862 EL CAJON BLVD
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-6712
Practice Address - Country:US
Practice Address - Phone:801-953-5957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT54014671205207N00000X
CAA98484207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100509884Medicaid
ID807481200Medicaid
UT8704683770001Medicaid