Provider Demographics
NPI:1568771780
Name:KIM, CINDY
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1882 E 104TH AVE
Mailing Address - Street 2:1612
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-4309
Mailing Address - Country:US
Mailing Address - Phone:720-323-0237
Mailing Address - Fax:
Practice Address - Street 1:1882 E 104TH AVE
Practice Address - Street 2:#1612
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-4309
Practice Address - Country:US
Practice Address - Phone:720-323-0237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO26096164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse