Provider Demographics
NPI:1609305853
Name:LANE, KIMBERLY (MS, CGC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 GATEWAY BLVD STE 380
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-7420
Mailing Address - Country:US
Mailing Address - Phone:866-741-5331
Mailing Address - Fax:
Practice Address - Street 1:701 GATEWAY BLVD STE 380
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-7420
Practice Address - Country:US
Practice Address - Phone:866-741-5331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
170300000X
TX170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS