Provider Demographics
NPI:1740554161
Name:LOUIE, KIMBERLY
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:LOUIE
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 1:9 COBBLELAKE CT
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-4319
Mailing Address - Country:US
Mailing Address - Phone:916-275-3403
Mailing Address - Fax:
Practice Address - Street 1:2505 WYCLIFF AVE
Practice Address - Street 2:STE B
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-2624
Practice Address - Country:US
Practice Address - Phone:214-780-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX277091223G0001X
CA609321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice