Provider Demographics
NPI:1700692100
Name:KIMA, MATILDA
Entity type:Individual
Prefix:
First Name:MATILDA
Middle Name:
Last Name:KIMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7509 XENIA LN N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55443-3145
Mailing Address - Country:US
Mailing Address - Phone:513-338-6689
Mailing Address - Fax:
Practice Address - Street 1:7509 XENIA LN N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55443-3145
Practice Address - Country:US
Practice Address - Phone:513-338-6689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health