Provider Demographics
NPI:1972750370
Name:KIM, GRACE KYUNG (DO)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:KYUNG
Last Name:KIM
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:2615 BOX CANYON DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0450
Mailing Address - Country:US
Mailing Address - Phone:702-998-9001
Mailing Address - Fax:702-998-4999
Practice Address - Street 1:2615 BOX CANYON DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0450
Practice Address - Country:US
Practice Address - Phone:702-998-9001
Practice Address - Fax:702-998-4999
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2016-09-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NVDO1788207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery