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General NPI Number Information
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NPI Number | 1467503920
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Entity Type | Individual
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Provider Name | JIN KOO KIM MD
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Gender | Female
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 02/07/2019
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Provider Practice Location Address
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Address Line | 2580 HIGHWAY 95 STE 224
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442-7332
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Country | US
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Telephone | 928-763-7722
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Fax | 928-763-7744
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Provider Business Mailing Address
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Address Line | 6622 N 91ST AVE STE 220
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City | GLENDALE
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State | AZ
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Zip | 85305-2569
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Country | US
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Telephone | 602-759-6883
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Fax | 602-224-3358
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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 | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 41404
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License Number State | AZ
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