Provider Demographics
NPI:1134625866
Name:KIMBALL, SAVANNAH ENDERS (MD)
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:ENDERS
Last Name:KIMBALL
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 1:2110 E EL SEGUNDO BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-2743
Mailing Address - Country:US
Mailing Address - Phone:310-748-8745
Mailing Address - Fax:310-893-0431
Practice Address - Street 1:2110 E EL SEGUNDO BLVD STE 220
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-2743
Practice Address - Country:US
Practice Address - Phone:310-748-8745
Practice Address - Fax:310-893-0431
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA163699207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program