Individual
KIMIKNU MENTORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5966 W CURTISIAN AVE, BOISE, ID 83704-8801
(208) 302-5450
Mailing address
PO BOX 190930, BOISE, ID 83719-0930
(208) 367-5170
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2771058
ID
207RI0200X
Infectious Disease Physician
MD2024-0242
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/21/2018
Last updated
10/09/2025
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