Provider Demographics
NPI:1407246978
Name:KIMBLE, ELIJAH
Entity type:Individual
Prefix:
First Name:ELIJAH
Middle Name:
Last Name:KIMBLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3553 ATLANTIC AVE # 1200
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-5606
Mailing Address - Country:US
Mailing Address - Phone:562-751-5242
Mailing Address - Fax:562-751-5242
Practice Address - Street 1:3553 ATLANTIC AVE # 1200
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-5606
Practice Address - Country:US
Practice Address - Phone:562-751-5242
Practice Address - Fax:562-751-5242
Is Sole Proprietor?:No
Enumeration Date:2015-02-04
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner