Active NPI
Kim Marie Kubal
- Student in an Organized Health Care Education/Training Program
- San Mateo, CA
National Provider Identifier
1225554538
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- License
- 27396
- Practice address
- 2600 S El Camino Real Ste 200
San Mateo, CA 94403-2382 - Phone
- (650) 372-4080
- NPI assigned
- Aug 17, 2017
- Last updated
- Sep 26, 2017
- 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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 27396 | CA | Primary |
Addresses
Primary practice location
2600 S El Camino Real Ste 200
San Mateo, CA 94403-2382
Mailing address
1275 El Camino Real Apt 106
Millbrae, CA 94030-1405
Phone (650) 455-2030
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27396 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1502928000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1506384000000",
"number": "1225554538",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1275 EL CAMINO REAL APT 106",
"city": "MILLBRAE",
"state": "CA",
"postal_code": "940301405",
"telephone_number": "650-455-2030"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2600 S EL CAMINO REAL STE 200",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944032382",
"telephone_number": "650-372-4080"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUBAL",
"first_name": "KIM",
"middle_name": "MARIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-08-17",
"last_updated": "2017-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "CA",
"license": "27396",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Mateo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.