Individual
ADAM KIMBALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4671 GARDEN SPRING LN, SALT LAKE CITY, UT 84117-5021
(801) 518-0954
Mailing address
4671 S GARDEN SPRING LN, SALT LAKE CITY, UT 84117-5021
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A263029
DRIVERS LICENSE
OR
Enumeration date
06/01/2016
Last updated
06/01/2016
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