Benita Kimball, CMF

Primary specialty

Mastectomy FitterTaxonomy code 224900000X

License

C52184 Issued in CA

Practice address

1329 Howe Ave Ste 101
Sacramento, CA 95825-3363

Phone

(916) 480-9501

Fax

(510) 350-9166

NPI assigned

Sep 11, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• At Last Bra and Lingerie Boutique LLC

  • Prosthetic/Orthotic Supplier
  • Sacramento, CA
  • NPI 1245698984
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1441929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708992000000",
    "number": "1053789602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1329 HOWE AVE STE 101",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958253363",
            "telephone_number": "916-480-9501",
            "fax_number": "510-350-9166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1329 HOWE AVE STE 101",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958253363",
            "telephone_number": "916-480-9501",
            "fax_number": "510-350-9166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIMBALL",
        "first_name": "BENITA",
        "name_prefix": "Ms.",
        "credential": "CMF",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-11",
        "last_updated": "2024-02-27",
        "certification_date": "2024-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Z00000X",
            "taxonomy_group": "",
            "desc": "Orthotist",
            "state": "CA",
            "license": "C52184",
            "primary": false
        },
        {
            "code": "224900000X",
            "taxonomy_group": "",
            "desc": "Mastectomy Fitter",
            "state": "CA",
            "license": "C52184",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOC",
            "identifier": "C52184",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Yo Sup Kim, MD
• Yong J Kim, D.C.
• Yongsuk Kim, L.AC.
• Amos Gicheha Kimani
• David Kimathi, BS
• Isabella Kimball
• Kilianne Rhea Kimball, PH.D..
• William R. Kimball, MD
• Kimberly & Beverly'S Guest Home
• Christina Kimble

• Mastectomy Fitter in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Mastectomy Fitter in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.