Provider Demographics
NPI:1013968361
Name:DREHER, KIMBERLY ANN (DO)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:DREHER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:3667 SEDLOCK DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-8434
Mailing Address - Country:US
Mailing Address - Phone:951-343-3481
Mailing Address - Fax:951-343-3486
Practice Address - Street 1:3667 SEDLOCK DR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-8434
Practice Address - Country:US
Practice Address - Phone:951-343-3481
Practice Address - Fax:951-343-3486
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8203208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A8203OtherLICENSE