Individual
GRACE J KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
902 LAKEVIEW AVE, PUEBLO, CO 81004-3597
(719) 557-5855
Mailing address
902 LAKEVIEW AVE, PUEBLO, CO 81004-3597
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DR.0069963
CO
Other
Enumeration date
05/18/2021
Last updated
07/12/2024
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