Healthcare Provider Details

I. General information

NPI: 1477334373
Provider Name (Legal Business Name): JAIME KIM REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6650 S VINE ST STE 100
CENTENNIAL CO
80121-2740
US

IV. Provider business mailing address

15717 E BRONCOS PL
CENTENNIAL CO
80112-4755
US

V. Phone/Fax

Practice location:
  • Phone: 303-535-7548
  • Fax: 888-504-2390
Mailing address:
  • Phone: 720-340-9966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.1001389-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1671048
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: