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General NPI Number Information
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NPI Number | 1205397346
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Entity Type | Individual
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Provider Name | GRACE EUN KIM DO
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Gender | Female
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Dates
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Enumeration Date | 03/30/2019
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Last Update Date | 11/30/2021
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Provider Practice Location Address
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Address Line | 10465 MELODY DR STE 322
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City | NORTHGLENN
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State | CO
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Zip | 80234-4126
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Country | US
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Telephone | 720-934-1842
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Fax |
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Provider Business Mailing Address
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Address Line | 15684 E 47TH DR
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City | DENVER
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State | CO
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Zip | 80239-5522
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Country | US
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Telephone | 720-934-1842
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DR.0065467
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 0065467
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License Number State | CO
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