Kimberly Joanna Wolf, DO

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

20A16000 Issued in CA

Practice address

2201 Courage Dr
Fairfield, CA 94533-6733

Phone

(707) 469-4640

NPI assigned

Mar 31, 2010

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

Other names 1

• Kimberly Joanna Grantz-Wolf Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1269993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512345600000",
    "number": "1326363581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1310 CLUB DR",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945921187",
            "telephone_number": "707-638-5963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 COURAGE DR",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945336733",
            "telephone_number": "707-469-4640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLF",
        "first_name": "KIMBERLY",
        "middle_name": "JOANNA",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-31",
        "last_updated": "2017-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "34010573",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "20A16000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0082608",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "GRANTZ-WOLF",
            "middle_name": "JOANNA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Stephany Michelle Winston, MPSS-CVFXLS
• Malgorzata Winter, RN
• Daryl Wise
• With Love Home Care
• Anthony Witherow
• Victoria Wong-Chiu, PHARMD
• Godfrey E Wong, MD
• Maya Wong
• Franklin Woo, D.D.S.
• Kristin Woodbury, D.O.

• Pediatrics Physician in Fairfield, CA
• Providers in Fairfield, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 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.

Verify at the official NPI Registry.