Provider Demographics
NPI:1992747083
Name:KRANTZ JENNINGS, KIMBERLY D (AUD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:D
Last Name:KRANTZ JENNINGS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:KRANTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:1860 EL CAMINO REAL
Mailing Address - Street 2:SUITE 304
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3127
Mailing Address - Country:US
Mailing Address - Phone:650-477-9794
Mailing Address - Fax:
Practice Address - Street 1:1860 EL CAMINO REAL
Practice Address - Street 2:SUITE 304
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3127
Practice Address - Country:US
Practice Address - Phone:650-477-9794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2330231H00000X
CAHA 7034237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AU23300Medicaid
CA00AU23300Medicare PIN