Provider Demographics
NPI:1134160666
Name:KINMAN, RENEE ANNETTE POULIN (MD)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:ANNETTE POULIN
Last Name:KINMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 E DIVISADERO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1431
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:726 N MEDICAL CENTER DR E STE 209
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6886
Practice Address - Country:US
Practice Address - Phone:559-325-5656
Practice Address - Fax:559-325-5568
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92381207R00000X, 208000000X, 2080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI37653Medicare UPIN
CA00A923810Medicare ID - Type Unspecified