Provider Demographics
NPI:1629089636
Name:SOREM, KIMBERLEE ANN (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:ANN
Last Name:SOREM
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 1:3239 SACRAMENTO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2047
Mailing Address - Country:US
Mailing Address - Phone:415-815-9501
Mailing Address - Fax:415-863-9528
Practice Address - Street 1:3239 SACRAMENTO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2047
Practice Address - Country:US
Practice Address - Phone:415-815-9501
Practice Address - Fax:415-863-9528
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79456207VM0101X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACG879XMedicare PIN