Kimberly J Wonderlich MD Faad Dermatology LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

8102 Issued in AK

Legal business name

KIMBERLY J WONDERLICH MD FAAD DERMATOLOGY LLC

Practice address

2775 College Road
Fairbanks, AK 99709

Phone

(907) 456-1979

NPI assigned

May 29, 2015

Last updated

Feb 13, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kimberly WonderlichNPI 1346211505

Title

Managing Member

Phone

(907) 456-1979

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AK

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kimberly Janne Wonderlich, M.D.

  • Dermatology Physician
  • Fairbanks, AK
  • NPI 1346211505
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1432857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1550016000000",
    "number": "1396124897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2775 COLLEGE RD",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997093751",
            "telephone_number": "907-456-1979",
            "fax_number": "907-456-1903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2775 COLLEGE ROAD",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "99709",
            "telephone_number": "907-456-1979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIMBERLY J WONDERLICH MD FAAD DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-29",
        "last_updated": "2019-02-13",
        "status": "A",
        "authorized_official_last_name": "WONDERLICH",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "907-456-1979"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "AK",
            "license": "8102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Killian, RN
• Brian Killion
• Jason Kim
• Sam Y Kim, M.D.
• Jim R Kimbal, ATC, LAT, LMT, CSCS
• Heidie Kimmel
• Claire Joann Kindschi, OTD
• Kathryn L Kindt, ADVANCED NURSE PRACT
• King Cab Inc
• Jordan Antonia King

• Dermatology Physician in Fairbanks, AK
• Providers in Fairbanks, AK by specialty
• Dermatology Physician in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.