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General NPI Number Information
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NPI Number | 1326559568
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Entity Type | Individual
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Provider Name | MELISSA JOY KIM PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/16/2017
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 15396 N 83RD AVE STE E
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City | PEORIA
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State | AZ
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Zip | 85381-5627
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Country | US
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Telephone | 480-561-3062
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Fax |
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Provider Business Mailing Address
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Address Line | 6627 W BENT TREE DR
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City | PHOENIX
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State | AZ
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Zip | 85083-7525
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Country | US
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Telephone | 623-695-4430
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 6926
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License Number State | AZ
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