Provider Demographics
NPI:1598991176
Name:GAITHER, KIMBERLY ANN (RDHAP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:GAITHER
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3717 S LA BREA AVE
Mailing Address - Street 2:#520
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-5300
Mailing Address - Country:US
Mailing Address - Phone:310-776-0055
Mailing Address - Fax:310-671-1089
Practice Address - Street 1:3717 S LA BREA AVE
Practice Address - Street 2:#520
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016-5300
Practice Address - Country:US
Practice Address - Phone:310-776-0055
Practice Address - Fax:310-671-1089
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA260124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist