Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 41487 | AZ |
N | 207ND0101X | MOHS-Micrographic Surgeon | 41487 | AZ |
NPI | 1396955076 |
---|---|
Provider Name | Dr. Nancy Hageung Kim |
First Address | Scottsdale, AZ 85258-4582 |
Second Address | Scottsdale, AZ 85258-4582 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 16/08/2017 |