Provider Demographics
NPI:1730615477
Name:KYMRY FOWLER, INC.
Entity type:Organization
Organization Name:KYMRY FOWLER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KYMRY
Authorized Official - Middle Name:HART
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-374-4868
Mailing Address - Street 1:20122 SANTA ANA AVE
Mailing Address - Street 2:7C
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1360
Mailing Address - Country:US
Mailing Address - Phone:949-374-4868
Mailing Address - Fax:949-606-8262
Practice Address - Street 1:20122 SANTA ANA AVE
Practice Address - Street 2:7C
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1360
Practice Address - Country:US
Practice Address - Phone:949-374-4868
Practice Address - Fax:949-606-8262
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1957
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17425261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech