Provider Demographics
NPI:1760718985
Name:KIM-HAYES, WANDA SUE (PA)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:SUE
Last Name:KIM-HAYES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1206
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93116-1206
Mailing Address - Country:US
Mailing Address - Phone:805-687-5538
Mailing Address - Fax:805-687-5530
Practice Address - Street 1:601 E ARRELLAGA ST STE 101
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93103-2275
Practice Address - Country:US
Practice Address - Phone:805-687-5538
Practice Address - Fax:805-687-5530
Is Sole Proprietor?:No
Enumeration Date:2009-10-22
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20523363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA20523OtherLICENSE
CA1086592OtherNAT'L COMM ON CERTIFICATION OF PHYSICIAN ASSISTANTS