Provider Demographics
NPI:1326559568
Name:KIM, MELISSA JOY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JOY
Last Name:KIM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6627 W BENT TREE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-7525
Mailing Address - Country:US
Mailing Address - Phone:623-695-4430
Mailing Address - Fax:
Practice Address - Street 1:14418 W MEEKER BLVD STE 210
Practice Address - Street 2:DEL WEBB MEDICAL PLAZA, BLDG B
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-5283
Practice Address - Country:US
Practice Address - Phone:623-544-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6926207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine