Provider Demographics
NPI:1124238308
Name:GIBBS, KATHRYN A (MD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:A
Last Name:GIBBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:KATHRYN
Other - Middle Name:G
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9811 RYAN CIR
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:92861-2710
Mailing Address - Country:US
Mailing Address - Phone:714-998-4206
Mailing Address - Fax:714-998-4206
Practice Address - Street 1:9811 RYAN CIR
Practice Address - Street 2:
Practice Address - City:VILLA PARK
Practice Address - State:CA
Practice Address - Zip Code:92861-2710
Practice Address - Country:US
Practice Address - Phone:714-998-4206
Practice Address - Fax:714-998-4206
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40440207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine