Provider Demographics
NPI:1558689984
Name:SOBELL, KIMBERLY ANJA (DO)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANJA
Last Name:SOBELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:SOBELL
Other - Last Name:HEUGELE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:600 NE 8TH ST STE 301
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7317
Mailing Address - Country:US
Mailing Address - Phone:503-988-5155
Mailing Address - Fax:503-988-5185
Practice Address - Street 1:600 NE 8TH ST STE 300
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7318
Practice Address - Country:US
Practice Address - Phone:503-988-5155
Practice Address - Fax:503-988-5185
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-10
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR210173208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics