Provider Demographics
NPI:1972208791
Name:JOSEPH, KIMATAKAYA M (CMT)
Entity Type:Individual
Prefix:
First Name:KIMATAKAYA
Middle Name:M
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:KIMA
Other - Middle Name:M
Other - Last Name:JOSEPH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CMT
Mailing Address - Street 1:3231 PRENTISS ST APT E
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-2643
Mailing Address - Country:US
Mailing Address - Phone:510-469-7119
Mailing Address - Fax:
Practice Address - Street 1:3231 PRENTISS ST APT E
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-2643
Practice Address - Country:US
Practice Address - Phone:510-469-7119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70962225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist