Provider Demographics
NPI:1588682769
Name:KIM, ANNA BELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:BELLE
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:697 W TEFFT ST
Mailing Address - Street 2:
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444-9190
Mailing Address - Country:US
Mailing Address - Phone:805-929-2272
Mailing Address - Fax:805-929-1454
Practice Address - Street 1:697 W TEFFT ST
Practice Address - Street 2:
Practice Address - City:NIPOMO
Practice Address - State:CA
Practice Address - Zip Code:93444-9190
Practice Address - Country:US
Practice Address - Phone:805-929-2272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM11345207R00000X
CAA81160207R00000X, 208000000X
HI15215208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics