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NPI Code Detail

MEDICARE: DR. GRACE KYUNG KIM D.O.

MEDICARE: DR. GRACE KYUNG KIM D.O.
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
1207ND0101XMOHS-Micrographic Surgery PhysicianDO1788NV

General Provider Information

NPI Number : 1972750370
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GRACE KYUNG KIM D.O.
Provider Business Mailing Address
First Line : 2615 BOX CANYON DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-0450
Country : US
Telephone Number : 702-998-9001
Fax Number : 702-998-4999
Provider Business Practice Location Address
First Line : 2615 BOX CANYON DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-0450
Country : US
Telephone Number : 702-998-9001
Fax Number : 702-998-4999
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2008
Last Update Date : 09/28/2016

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