Provider Demographics
NPI:1780090555
Name:BINGO, KIM (LAC)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:BINGO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:FLOREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:6761 W YALE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-4075
Mailing Address - Country:US
Mailing Address - Phone:720-272-4064
Mailing Address - Fax:
Practice Address - Street 1:6761 W YALE AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-4075
Practice Address - Country:US
Practice Address - Phone:720-272-4064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO724171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist