MEDICARE: KIM VO CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	111899	CT
2	367500000X	Certified Registered Nurse Anesthetist	11009103	FL
3	367500000X	Certified Registered Nurse Anesthetist	122911	CT
4	367500000X	Certified Registered Nurse Anesthetist	202200283CRNA	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538638978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM VO CRNA

Provider Business Mailing Address
First Line	:	228 HAMILTON ST
Second Line	:
City	:	MERIDEN
State	:	CT
Zip	:	06451-3815
Country	:	US
Telephone Number	:	203-317-7852
Fax Number	:

Provider Business Practice Location Address
First Line	:	228 HAMILTON ST
Second Line	:
City	:	MERIDEN
State	:	CT
Zip	:	06451-3815
Country	:	US
Telephone Number	:	203-317-7852
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2018
Last Update Date	:	06/12/2025

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Directions to “ KIM VO CRNA” Practice Location

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