Provider Demographics
NPI:1750835815
Name:KIM, PAIGE LIVINGSTON
Entity Type:Individual
Prefix:MISS
First Name:PAIGE
Middle Name:LIVINGSTON
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 1:2121 E HARMONY RD UNIT 160
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-3413
Mailing Address - Country:US
Mailing Address - Phone:970-482-3328
Mailing Address - Fax:970-482-1433
Practice Address - Street 1:2121 E HARMONY RD UNIT 160
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-3413
Practice Address - Country:US
Practice Address - Phone:970-482-3328
Practice Address - Fax:970-482-1433
Is Sole Proprietor?:No
Enumeration Date:2016-08-06
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53784363A00000X
COPA.0004765363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant