Provider Demographics
NPI:1306724216
Name:KIM CHRISTOPHER KNUDSON DO PLLC
Entity type:Organization
Organization Name:KIM CHRISTOPHER KNUDSON DO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHILD & ADOLESCENT PSYCHIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:KNUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO, MBA
Authorized Official - Phone:208-221-8088
Mailing Address - Street 1:5310 W MAGGIO DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-7466
Mailing Address - Country:US
Mailing Address - Phone:208-221-8088
Mailing Address - Fax:
Practice Address - Street 1:413 N ALLUMBAUGH ST STE 101
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9219
Practice Address - Country:US
Practice Address - Phone:208-323-1125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty