Provider Demographics
NPI:1447317771
Name:CHARLTON, KIMBERLY ANN (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANN
Last Name:CHARLTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6255 W SUNSET BLVD FL 21
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-7422
Mailing Address - Country:US
Mailing Address - Phone:323-498-6674
Mailing Address - Fax:855-312-7678
Practice Address - Street 1:1400 S GRAND AVE STE 801
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3068
Practice Address - Country:US
Practice Address - Phone:213-741-9727
Practice Address - Fax:213-741-0867
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00516782084P0800X, 2084P0804X
HIMD115302084P0800X
CAG888432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00A0232304OtherHMSA-QUEST
CO74659014Medicaid
HIMD11530OtherMDX HAWAII
HI990298651-96706-E049OtherTRICARE
HI961761OtherUNIVERSITY HEALTH ALLIANC
HI00A0232304OtherHMSA
HI1236OtherALOHACARE
HI523317-01Medicaid
HI990298651-96706-E049OtherTRICARE
HI55067Medicare ID - Type Unspecified