Provider Demographics
NPI:1932255668
Name:KIMBALL, AMY L (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:L
Last Name:KIMBALL
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:200 WEST ARBOR DR.
Mailing Address - Street 2:MAIL CODE - 8774
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-8774
Mailing Address - Country:US
Mailing Address - Phone:619-543-3759
Mailing Address - Fax:619-543-3812
Practice Address - Street 1:200 WEST ARBOR DR.
Practice Address - Street 2:MAIL CODE - 8774
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-8774
Practice Address - Country:US
Practice Address - Phone:619-543-3759
Practice Address - Fax:619-543-3812
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA876962080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I046286Medicare UPIN