Provider Demographics
NPI:1639403454
Name:IVORY, KIMBERLY JUNE (MS)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:JUNE
Last Name:IVORY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11234 ANDERSON ST
Mailing Address - Street 2:#3400
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2804
Mailing Address - Country:US
Mailing Address - Phone:909-651-5981
Mailing Address - Fax:909-558-0384
Practice Address - Street 1:11234 ANDERSON ST
Practice Address - Street 2:#3400
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2804
Practice Address - Country:US
Practice Address - Phone:909-651-5981
Practice Address - Fax:909-558-0384
Is Sole Proprietor?:No
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS