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NPI Code Detail

MEDICARE: MICHELLE LEE KIM MD

MEDICARE: MICHELLE LEE KIM MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2208000000XPediatrics Physician0077244CO

General Provider Information

NPI Number : 1972208486
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE LEE KIM MD
Provider Business Mailing Address
First Line : 13123 E 16TH AVE
Second Line :
City : AURORA
State : CO
Zip : 80045-7106
Country : US
Telephone Number : 720-777-1234
Fax Number :
Provider Business Practice Location Address
First Line : 4650 W SUNSET BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90027-6062
Country : US
Telephone Number : 323-660-2450
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2023
Last Update Date : 04/25/2026

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