Provider Demographics
NPI:1336343276
Name:SNIDER, KIMIKO MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMIKO
Middle Name:MARIE
Last Name:SNIDER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3900 INLET ISLE DR
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-1604
Mailing Address - Country:US
Mailing Address - Phone:949-706-1736
Mailing Address - Fax:949-612-1845
Practice Address - Street 1:360 SAN MIGUEL DR
Practice Address - Street 2:SUITE 206
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7853
Practice Address - Country:US
Practice Address - Phone:949-640-4455
Practice Address - Fax:949-640-4445
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2013-07-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG87862207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F63809Medicare UPIN