Provider Demographics
NPI:1639141070
Name:JOSEN, KIM I (MD)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:I
Last Name:JOSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3370 N. HAYDEN RD
Mailing Address - Street 2:#123-407
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251
Mailing Address - Country:US
Mailing Address - Phone:480-947-1130
Mailing Address - Fax:480-947-1132
Practice Address - Street 1:3370 N. HAYDEN RD
Practice Address - Street 2:# 123-407
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251
Practice Address - Country:US
Practice Address - Phone:480-947-1130
Practice Address - Fax:480-947-1132
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28220207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ520305Medicaid
106599Medicare ID - Type Unspecified
AZ520305Medicaid