Provider Demographics
NPI:1700517778
Name:ALDECOA, KIM ABBEGAIL TAN
Entity Type:Individual
Prefix:
First Name:KIM ABBEGAIL
Middle Name:TAN
Last Name:ALDECOA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:ST. JOSEPH MERCY OAKLAND HOSPITAL,44405 WOODWARD AVENUE
Mailing Address - Street 2:MEDICAL EDUCATION DEPARTMENT H23
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341
Mailing Address - Country:US
Mailing Address - Phone:248-858-6233
Mailing Address - Fax:248-858-3244
Practice Address - Street 1:ST. JOSEPH MERCY OAKLAND HOSPITAL,44405 WOODWARD AVENUE
Practice Address - Street 2:MEDICAL EDUCATION DEPARTMENT H23
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341
Practice Address - Country:US
Practice Address - Phone:248-858-6233
Practice Address - Fax:248-858-3244
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program