Provider Demographics
NPI:1295150365
Name:RUBY, KIM MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:MARIE
Last Name:RUBY
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 1:3750 CONVOY ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-3738
Mailing Address - Country:US
Mailing Address - Phone:858-278-8031
Mailing Address - Fax:
Practice Address - Street 1:3750 CONVOY ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-3738
Practice Address - Country:US
Practice Address - Phone:858-278-8031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-26
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA126050207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery