Provider Demographics
NPI:1902937386
Name:HAMILTON, KIMBERLY ANN (LAC, DNBAO, CIDE,)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ANN
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:LAC, DNBAO, CIDE,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POST OFFICE BOX 562
Mailing Address - Street 2:GENERAL DELIVERY
Mailing Address - City:SOMES BAR
Mailing Address - State:CA
Mailing Address - Zip Code:95568-9999
Mailing Address - Country:US
Mailing Address - Phone:707-965-2955
Mailing Address - Fax:
Practice Address - Street 1:GENERAL DELIVERY
Practice Address - Street 2:562 ANGWIN
Practice Address - City:SOMES BAR
Practice Address - State:CA
Practice Address - Zip Code:95568-9999
Practice Address - Country:US
Practice Address - Phone:707-965-2955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3319171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist