Provider Demographics
NPI:1912149071
Name:KIMMERLING, REUVEN (MD)
Entity Type:Individual
Prefix:
First Name:REUVEN
Middle Name:
Last Name:KIMMERLING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RUDY
Other - Middle Name:
Other - Last Name:KIMMERLING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:9400 ROSECRANS AVE
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-2246
Mailing Address - Country:US
Mailing Address - Phone:562-461-4815
Mailing Address - Fax:
Practice Address - Street 1:9449 IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-2814
Practice Address - Country:US
Practice Address - Phone:562-461-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-03
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA121567207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine