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General NPI Number Information
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NPI Number | 1639134620
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Entity Type | Individual
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Provider Name | KOH BOAYUE MD
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Gender | Female
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Dates
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Enumeration Date | 04/20/2006
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 2211 LOMAS BLVD NE 3RD FLOOR
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-2745
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Country | US
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Telephone | 505-272-4461
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Fax | 505-272-8699
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Provider Business Mailing Address
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Address Line | 800 BRADBURY DR SE STE 116
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-4310
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Country | US
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Telephone | 505-272-1476
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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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | O1060668A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 2080P0207X
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Taxonomy Name | Pediatric Hematology & Oncology Physician
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License Number | MD2009-0038
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License Number State | NM
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