Provider Demographics
NPI:1689744377
Name:IMAJO, KIMBERLY M (AUD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:M
Last Name:IMAJO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7275 GLEN FOREST DRIVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226
Mailing Address - Country:US
Mailing Address - Phone:804-282-0022
Mailing Address - Fax:804-282-2441
Practice Address - Street 1:7275 GLEN FOREST DRIVE
Practice Address - Street 2:SUITE 208
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226
Practice Address - Country:US
Practice Address - Phone:804-282-0022
Practice Address - Fax:804-282-2441
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101001343237700000X
VA2201001143231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist