KIMBERLY LARSON (NPI# 1730473885) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730473885 |
| Entity Type | Individual |
| Full Name | KIMBERLY LARSON |
| Other Name | KIMBERLY BOUCHARD |
| Credential | MD |
| Practice Address |
747 52nd St Oakland CA 94609 |
| Mailing Address |
747 52nd St Oakland CA 94609-1809 |
| Practice Telephone | 5104283276 |
| Mailing Telephone | 5104283276 |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2019-10-07 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080N0001X |
Pediatrics Specialization: Neonatal-Perinatal Medicine |
A148236 | CA | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 11100 Euclid Ave, Mailstop 6010, Cleveland, OH 441061716 | 2168443387 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508406067 | Kimberly Anna Larson | Acupuncturist | 1601 2nd Ave N Ste 450h, Great Falls, MT 59401-3259 | 2020-01-13 |
| 1538688635 | Kimberly Larson | Speech-Language Pathologist | 800 Barberry Way, Joliet, IL 60431-7917 | 2017-09-11 |
| 1780003160 | Kimberly Larson | Physical Therapy Assistant | 30980 Scott Park Rd Trlr 72, Long Grove, IA 52756-9641 | 2014-04-14 |
| 1851465694 | Kimberly Rae Larson | Dietitian, Registered | 120 N 19th Ave Ste D, Bozeman, MT 59718-3920 | 2006-11-20 |
| 1982614723 | Kimberly S Larson | Nurse Practitioner | 170 Arrowhead Dr, Evanston, WY 82930-9266 | 2006-08-08 |
| 1972545978 | Kimberly D. Larson | Nurse Practitioner | 3170 State St, Medford, OR 97504-8450 | 2006-06-12 |
| 1215903752 | Kimberly C Larson | Physician Assistant | 2420 S Union, Ste 300, Tacoma, WA 98405-1387 | 2006-02-24 |
| 1033430822 | Kimberly Larson | Counselor | 404 Lincoln Blvd, Venice, CA 90291-2829 | 2010-06-16 |
| 1558546135 | Kimberly Raquell Larson | Nurse Practitioner | 7211 W Deschutes Ave, Ste D-101, Kennewick, WA 99336-7728 | 2008-01-02 |
| 1629299011 | Kimberly D Larson | Massage Therapist | 100 N Pines Rd, Spokane Valley, WA 99206-5117 | 2007-05-01 |
| Street Address |
747 52ND ST |
| City | OAKLAND |
| State | CA |
| Zip Code | 94609 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942200928 | James Philip Riddel Jr. | Nurse Practitioner | 747 52nd St, Oakland, CA 94609-1809 | 2005-07-29 |
| 1235739905 | Maria Elena Alicia Valdivia Fortuna | Social Worker | 747 52nd St, Oakland, CA 94609-1809 | 2020-10-30 |
| 1295342707 | Jenny Chen | Dietitian, Registered | 747 52nd St, Oakland, CA 94609-1809 | 2020-09-29 |
| 1104433028 | Phuong T Nguyen-tran | Pharmacist | 747 52nd St, Oakland, CA 94609-1809 | 2020-09-24 |
| 1114538899 | Ji Yun Lee | Student in an Organized Health Care Education/Training Program | 747 52nd St, Oakland, CA 94609-1809 | 2020-08-14 |
| 1780295857 | Luis Alonso Perez Jr. | Social Worker | 747 52nd St, Oakland, CA 94609-1809 | 2020-08-12 |
| 1255941803 | Aleesia Renta-ramirez | Student in an Organized Health Care Education/Training Program | 747 52nd St, Oakland, CA 94609-1809 | 2020-08-07 |
| 1831709773 | Carroll Taylor Brown IIi | Registered Nurse | 747 52nd St, Oakland, CA 94609-1809 | 2020-08-05 |
| 1053921064 | Jessica Stankiewicz Lightcap | Registered Nurse | 747 52nd St, Oakland, CA 94609-1809 | 2020-08-04 |
| 1184242307 | Cecilia Fairley | Genetic Counselor, MS | 747 52nd St, Oakland, CA 94609-1809 | 2020-07-14 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104457159 | Gerard John-charles Coughlin | Student in an Organized Health Care Education/Training Program | Samuel Merritt University, 3100 Telegraph Avenue, Oakland, CA 94609 | 2020-01-29 |
| 1417502022 | Michael Knittel | Registered Nurse | 370 Hawthorne Ave, Oakland, CA 94609 | 2019-08-09 |
| 1962057562 | Nicole Kjolby | Registered Nurse | Samuel Merritt College, 370 Hawthorne Ave, Oakland, CA 94609 | 2019-08-09 |
| 1396208286 | Graham Vallis | Student in an Organized Health Care Education/Training Program | Ucsf Benioff Children's Hospital Oakland, 747 52nd Street, Oakland, CA 94609 | 2019-04-09 |
| 1386129526 | Gary Mitchell Snider | Counselor | 390 40th Street, Oakland, CA 94609 | 2018-10-02 |
| 1720568389 | Lice Control Inc. | Technician | 6557 Shattuck Ave, Oakland, CA 94609 | 2018-08-14 |
| 1528559150 | Jenna Marie Kincaid | Behavior Technician | 400 29th St., 204, Oakland, CA 94609 | 2018-05-18 |
| 1336656669 | Nicholas Dicarlo | Social Worker | 465 34th St Ste 6, Oakland, CA 94609 | 2018-01-09 |
| 1174045744 | Theodora J Marzouk | Home Health Aide | 3317 Elm Street, Suite 202, Oakland, CA 94609 | 2017-07-14 |
| 1740728922 | Elena Gardella | Marriage & Family Therapist | 411 30th Street, Suite 412, Oakland, CA 94609 | 2017-02-07 |
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| Taxonomy Code | 2080N0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Neonatal-Perinatal Medicine |
| A pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with obstetrical colleagues to plan for the care of mothers who have high-risk pregnancies. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437504503 | Jaskiran Ranu | Pediatrics | 747 52nd St, Oakland, CA 94609-1809 | 2016-04-26 |
| 1659791499 | Sarah Styles | Pediatrics | 747 52nd St, Oakland, CA 94609-1809 | 2014-04-20 |
| 1013278787 | Spencer L Magargal | Pediatrics | 747 52nd St, Oakland, CA 94609-1809 | 2012-05-30 |
| 1255537163 | Joanna Halkias | Pediatrics | 747 52nd St, Neonatology 3rd Floor, Oakland, CA 94609-1809 | 2007-06-26 |
| 1154530566 | Kristin Elizabeth Hubert | Pediatrics | 747 52nd St, Neonatology, Oakland, CA 94609-1809 | 2007-05-22 |
| 1043375561 | East Bay Newborn Specialists, Inc. | Pediatrics | 747 52nd St, Neonatology Office, Oakland, CA 94609-1809 | 2006-12-26 |
| 1144230707 | Bradley Jackson Holden | Pediatrics | 1411 E 31st Street, Oak Care Med Grp, Oakland, CA 94602 | 2006-08-08 |
| 1982633004 | Namrata D. Jhaveri | Pediatrics | 275 W Macarthur, Oakland, CA 94611-5641 | 2006-07-01 |
| 1720017254 | Jeffrey D Merrill | Pediatrics | 747 52nd St, Neonatology - 3rd Floor, Oakland, CA 94609-1809 | 2006-06-30 |
| 1114968971 | Golde G Dudell | Pediatrics | 747 52nd St, 3rd Floor, Oakland, CA 94609-1809 | 2006-06-10 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.