Provider Demographics
NPI: | 1457555633 |
---|---|
Name: | KIM CORP |
Entity Type: | Organization |
Organization Name: | KIM CORP |
Other - Org Name: | ABBEY MEDICAL |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OFFICE MANAGER |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | ANA |
Authorized Official - Middle Name: | MARIZA |
Authorized Official - Last Name: | GONZALEZ |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 559-431-1000 |
Mailing Address - Street 1: | 6057 N PALM AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | FRESNO |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 93704-1623 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 559-431-1000 |
Mailing Address - Fax: | 559-432-8036 |
Practice Address - Street 1: | 6057 N PALM AVE |
Practice Address - Street 2: | |
Practice Address - City: | FRESNO |
Practice Address - State: | CA |
Practice Address - Zip Code: | 93704-1623 |
Practice Address - Country: | US |
Practice Address - Phone: | 559-431-1000 |
Practice Address - Fax: | 559-432-8036 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-06-12 |
Last Update Date: | 2009-05-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | 45389 | 332BC3200X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 332BC3200X | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment |