Provider Demographics
NPI:1710330246
Name:SMALLHORNE, KIM LEE
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:LEE
Last Name:SMALLHORNE
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 1:140 ALCOTT PL APT 27F
Mailing Address - Street 2:BUILDING 19
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-4310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:140 ALCOTT PL APT 27F
Practice Address - Street 2:BUILDING 19
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-4310
Practice Address - Country:US
Practice Address - Phone:718-320-3215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist