Ellen Kim
Family Doctor - Adult Medicine
4253 Montgomery Blvd Ne Suite 100
Albuquerque
, New Mexico 87109-1106
Ellen Kim
Family Doctor - Adult Medicine
4253 Montgomery Blvd Ne Suite 100
Albuquerque
, New Mexico 87109-1106
(505) 506-1984
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About
Features
Specialties
- Family Doctor - Adult Medicine
Languages spoken
- English
Location
First Address
- Ellen Kim
- 3015 10th St Nw
- Albuquerque, NM
- Zip : 87107-1112
- Phone : (505) 506-1984
Second Address
- Ellen Kim
- 4253 Montgomery Blvd Ne Suite 100
- Albuquerque, NM
- Zip : 87109-1106
- Fax : (505) 898-1518
- Phone : (505) 898-2468
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207QA0505X | Family Doctor - Adult Medicine | 97-289 | NM |
National Provider Identifier
| NPI | 1275600637 |
|---|---|
| Provider Name | Ellen Kim |
| First Address | Albuquerque, NM 87107-1112 |
| Second Address | Albuquerque, NM 87109-1106 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 29/11/2006 |
| Last Update Date | 23/12/2018 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| G55811 | (02) | CA |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.