Kimberly Kathryn Childers, M.S., C.G.C.

Primary specialty

Genetic Counselor (M.S.)Taxonomy code 170300000X

License

GC000547 Issued in CA

Practice address

181 S Buena Vista St
Burbank, CA 91505-4504

Phone

(818) 748-4762

Fax

(818) 748-4711

NPI assigned

Nov 7, 2011

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 names 1

• Kimberly Kathryn Vande Wydeven Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1320624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416182400000",
    "number": "1760769657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "181 S BUENA VISTA ST",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915054504",
            "telephone_number": "818-748-4761",
            "fax_number": "818-748-4711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "181 S BUENA VISTA ST",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915054504",
            "telephone_number": "818-748-4762",
            "fax_number": "818-748-4711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHILDERS",
        "first_name": "KIMBERLY",
        "middle_name": "KATHRYN",
        "name_prefix": "Mrs.",
        "credential": "M.S., C.G.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-11-07",
        "last_updated": "2014-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "170300000X",
            "taxonomy_group": "",
            "desc": "Genetic Counselor, MS",
            "state": "IL",
            "license": "246.000119",
            "primary": false
        },
        {
            "code": "170300000X",
            "taxonomy_group": "",
            "desc": "Genetic Counselor, MS",
            "state": "CA",
            "license": "GC000547",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "VANDE WYDEVEN",
            "middle_name": "KATHRYN",
            "credential": "M.S., C.G.C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Catherine Chern, MD
• Cheryl Twu DO Inc
• Yiu-Hang Cheung
• Pornpiroon Cheyiam
• Mallory Chick
• Elysia Chin, D.O.
• Janet Chin
• Glenda Chinchilla
• Sara Chinchuck
• Matthew Lawrence Ching, PT, DPT

• All providers in Burbank, CA
• Genetic Counselor (M.S.) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2014; 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.