Marya Susan Kimple, MS

Primary specialty

AudiologistTaxonomy code 231H00000X

License

AU2520 Issued in CA

Practice address

15 Southgate Ave
Ste 210
Daly City, CA 94015-1413

Phone

(650) 758-5363

NPI assigned

Jan 17, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Marya Susan Herzbrun Other name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299
  Medicare reassignment NPD
• Permanente Medical Group, Inc

  • Clinical Medical Laboratory
  • San Jose, CA
  • NPI 1497971584
  NPD

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641859200000",
    "number": "1578615035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 SOUTHGATE AVE",
            "address_2": "SUITE 210",
            "city": "DALY CITY",
            "state": "CA",
            "postal_code": "940151413",
            "telephone_number": "650-758-5363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 SOUTHGATE AVE",
            "address_2": "STE 210",
            "city": "DALY CITY",
            "state": "CA",
            "postal_code": "940151413",
            "telephone_number": "650-758-5363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIMPLE",
        "first_name": "MARYA",
        "middle_name": "SUSAN",
        "credential": "MS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-17",
        "last_updated": "2022-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "CA",
            "license": "AU2520",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "3900 Lakeville Hwy",
            "city": "Petaluma",
            "state": "CA",
            "country_code": "US",
            "postal_code": "949545698",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MARYA",
            "last_name": "HERZBRUN",
            "middle_name": "SUSAN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Han Seong Kim, D.C.
• Jennifer Wiley Kim
• Rachel Kim, PH.D
• Suk Won Kim
• Yong Hyeon Kim, D.C, LA.C
• Tomoki Kimura, MD
• Christina King
• Jenna Ariel King
• Divya R Kini, MD
• Rachel Kinnard, LMFT

• Audiologist in Daly City, CA
• Providers in Daly City, CA by specialty
• Audiologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.