Provider Demographics
NPI:1669426276
Name:GOODWIN, KIM M (MD)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:M
Last Name:GOODWIN
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Gender:F
Credentials:MD
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Mailing Address - Street 1:7695 CARDINAL CT
Mailing Address - Street 2:STE 240
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-3357
Mailing Address - Country:US
Mailing Address - Phone:858-277-9378
Mailing Address - Fax:858-277-9370
Practice Address - Street 1:7595 CARDINAL COURT
Practice Address - Street 2:SUITE 240
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-3357
Practice Address - Country:US
Practice Address - Phone:858-277-9378
Practice Address - Fax:858-277-9370
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2020-02-28
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Provider Licenses
StateLicense IDTaxonomies
CAA75600174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A756000Medicaid
CA00A756000Medicaid
CAH70554Medicare UPIN