Samuel Lewis Kimbles, PL.D. PSYCHOLOGY

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY3687 Issued in CA

Practice address

818 Cherry Street
Santa Rosa, CA 95404

Phone

(707) 544-6647

NPI assigned

Sep 15, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 1, 2015 through Oct 1, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1252972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1252972800000",
    "number": "1184957730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "818 CHERRY STREET",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "95404",
            "telephone_number": "707-544-6647",
            "fax_number": "707-544-6672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "818 CHERRY STREET",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "95404",
            "telephone_number": "707-544-6647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIMBLES",
        "first_name": "SAMUEL",
        "middle_name": "LEWIS",
        "credential": "PL.D. PSYCHOLOGY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-09-15",
        "last_updated": "2009-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY3687",
            "primary": true
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "CA",
            "license": "PSY3687",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven Park Kim, D.P.M.
• Susan Wanjiku Kimani, RN
• Naomi Knaak Kimball, PT
• Amalia Kimber, C.N.M., RN
• Kimberly Quan Hubenette,DDS, Inc
• Sean Kincaid
• King Hearing Aid Centers Inc
• Jeanna Maye King-Ruppel, CWC
• Chung Liang King, L.AC.
• Courtney King, MD

• Clinical Psychologist in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.