Provider Demographics
NPI:1790895167
Name:KIMURA, ROBYN L (MD)
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:L
Last Name:KIMURA
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 1:900 FLORIN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-3501
Mailing Address - Country:US
Mailing Address - Phone:916-421-8245
Mailing Address - Fax:916-421-9571
Practice Address - Street 1:900 FLORIN RD
Practice Address - Street 2:SUITE B
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-3501
Practice Address - Country:US
Practice Address - Phone:916-421-8245
Practice Address - Fax:916-421-9571
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73719208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A737190Medicaid