Provider Demographics
NPI:1891067682
Name:DURDIN, KIMBERLY ANN (LM, IBCLC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:DURDIN
Suffix:
Gender:F
Credentials:LM, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 SOUTHWEST DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-4528
Mailing Address - Country:US
Mailing Address - Phone:323-381-5511
Mailing Address - Fax:310-861-0255
Practice Address - Street 1:2610 SOUTHWEST DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-4528
Practice Address - Country:US
Practice Address - Phone:323-381-5511
Practice Address - Fax:310-861-0255
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
10218057174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA613Medicaid