Provider Demographics
NPI:1780657460
Name:MCILNAY, KIMBERLY RUTH (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:RUTH
Last Name:MCILNAY
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 1:1015 RILEY ST
Mailing Address - Street 2:PO BOX 1172
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95763-4006
Mailing Address - Country:US
Mailing Address - Phone:916-500-4195
Mailing Address - Fax:
Practice Address - Street 1:1015 RILEY ST
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95763-4006
Practice Address - Country:US
Practice Address - Phone:916-500-4195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-11
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98216207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine