Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 11567 | NV |
Y | 208600000X | Surgeon | 11567 | NV |
N | 2086S0102X | Surgical Critical Care | 11567 | NV |
NPI | 1033188289 |
---|---|
Provider Name | Kitae Kim |
First Address | Las Vegas, NV 89169-2579 |
Second Address | Las Vegas, NV 89169-2579 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 20/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100507450 | (05) | NV |
974445 | (05) | AZ |
I22508 | (02) | |
XPY205014 | (05) | CA |