Individual
KYLAN K LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2211 LOMAS BLVD NE, ALBUQUERQUE, NM 87106-2719
(505) 272-2111
Mailing address
10508 HACKAMORE PL SW, ALBUQUERQUE, NM 87121-8937
(479) 670-1319
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
RS2022-0464
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
NM
Other
Enumeration date
04/21/2022
Last updated
06/15/2022
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