Provider Demographics
NPI:1457398695
Name:KIMBALL, STEVEN T (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:T
Last Name:KIMBALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5530 BIRDCAGE ST
Mailing Address - Street 2:STE 145
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-7621
Mailing Address - Country:US
Mailing Address - Phone:209-956-7725
Mailing Address - Fax:209-956-7733
Practice Address - Street 1:6501 COYLE AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0306
Practice Address - Country:US
Practice Address - Phone:916-537-5000
Practice Address - Fax:916-851-2884
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2015-08-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG61543207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G615430Medicaid
CA00G615430Medicaid
E32521Medicare UPIN
CA00G615432Medicare PIN
CA00G615430OtherBLUE SHIELD OF CA
CA050011703Medicare PIN
CA00G615431Medicare PIN
E32521Medicare UPIN
CA00G615430Medicaid