Provider Demographics
NPI:1538181086
Name:KIMES, DONALD MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:MICHAEL
Last Name:KIMES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41880 KALMIA ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-8831
Mailing Address - Country:US
Mailing Address - Phone:951-696-7587
Mailing Address - Fax:951-461-6973
Practice Address - Street 1:41880 KALMIA ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-8831
Practice Address - Country:US
Practice Address - Phone:951-696-7587
Practice Address - Fax:951-461-6973
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6775207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020A67750Medicare ID - Type UnspecifiedMEDICARE ID
CAG81387Medicare UPIN