Provider Demographics
NPI:1972118305
Name:PUDBERRY, EDEN KIM (ND)
Entity Type:Individual
Prefix:DR
First Name:EDEN
Middle Name:KIM
Last Name:PUDBERRY
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6078 OLD QUARRY LOOP
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-3380
Mailing Address - Country:US
Mailing Address - Phone:415-726-7878
Mailing Address - Fax:
Practice Address - Street 1:6078 OLD QUARRY LOOP
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-3380
Practice Address - Country:US
Practice Address - Phone:415-726-7878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND327175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAND327OtherNATUROPATHIC MEDICINE COMMITTEE