Individual
KIMBERLY KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6177 RIVER CREST DR STE A, RIVERSIDE, CA 92507-0728
(951) 653-4480
Mailing address
6177 RIVER CREST DR STE A, RIVERSIDE, CA 92507-0728
(951) 653-4480
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
291911
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
291911
PT LICENSE
CA
Enumeration date
09/08/2016
Last updated
09/08/2016
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