Individual ProviderKimberly K HissongAnesthesiologyAllopathic & Osteopathic PhysiciansPractice Address3315 Watt Ave, Sacramento, CA 95821-3600(916) 481-6800PECOS EnrollmentBased on the most recent information from CMS, provider Kimberly K Hissong does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 9:30 AM.Profile DetailsProvider ID1194832006Provider TypeIndividualFull NameHissong, Kimberly KCredentialMDGenderFemaleSole ProprietorNoEnumeration Date8/24/2006Last Updated9/3/2020Contact InformationPractice LocationPractice Address3315 Watt Ave, Sacramento, CA 95821-3600Phone(916) 481-6800Fax(916) 481-1881Mailing LocationMailing Address3315 Watt Ave, Sacramento, CA 95821-3600Phone(916) 481-6800Fax(916) 481-1881Provider TaxonomiesCodeDescriptionLicenseCode207L00000XPrimaryDescriptionAnesthesiologyAllopathic & Osteopathic PhysiciansLicenseC139617CaliforniaCode207L00000XDescriptionAnesthesiologyAllopathic & Osteopathic PhysiciansLicense185262-1205UtahProvider IdentifiersIDDescriptionIssuerID107005891101DescriptionOtherIssuerIHCUtahID36403DescriptionOtherIssuerPEHPUtahID416939DescriptionOtherIssuerDESERET MUTUALUtahID09300DescriptionOtherIssuerVALLEY CHILDRENS HEALTHCARECaliforniaIDPR00880DescriptionOtherIssuerMOLINAUtahID2403DescriptionOtherIssuerHEALTHY UUtahID002084559DescriptionOtherIssuerFIRST HEALTHUtahID870280408HI1DescriptionOtherIssuerEDUCATORS MUTUALUtahID2000040DescriptionOtherIssuerUNITED HEALTHCAREUtahIDQM0000049524DescriptionOtherIssuerALTIUSUtahID002966900DescriptionMedicaidIssuerUnlistedIdahoID111000400DescriptionMedicaidIssuerUnlistedWyomingID401765DescriptionMedicaidIssuerUnlistedMontana