Active NPI
Lisa H Kimpark, M.D.
- Pediatrics Physician
- Glendora, CA
National Provider Identifier
1144312505
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- G065500
- Practice address
- 2025 E Route 66
Glendora, CA 91740-4670 - Phone
- (626) 963-3681
- NPI assigned
- Sep 29, 2006
- Last updated
- Nov 5, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | G065500 | CA | Primary |
Addresses
Primary practice location
2025 E Route 66
Glendora, CA 91740-4670
Mailing address
2025 E Route 66
Glendora, CA 91740-4670
Phone (626) 963-3681
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G065500 | CA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1352073600000",
"number": "1144312505",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2025 E ROUTE 66",
"city": "GLENDORA",
"state": "CA",
"postal_code": "917404670",
"telephone_number": "626-963-3681"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2025 E ROUTE 66",
"city": "GLENDORA",
"state": "CA",
"postal_code": "917404670",
"telephone_number": "626-963-3681"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIMPARK",
"first_name": "LISA",
"middle_name": "H",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-29",
"last_updated": "2012-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "G065500",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendora, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.