# KM DICKSON MEDICAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265642250
- **Authorized official:** KIMBERLY S DICKSON DO (PROVIDER)
- **Authorized official phone:** (619) 997-4502

## Contact information

- **Practice address:** 555 SATURN BLVD STE B292, SAN DIEGO, CA 92154-4766
- **Practice address phone:** (619) 591-9999
- **Mailing address:** 1008 OCEAN LN, IMPERIAL BEACH, CA 91932-2556
- **Mailing address phone:** (619) 591-9999

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/22/2007
- **Last updated:** 01/19/2017