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Individual

SE DUCK KIM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
516 NIZHONI BLVD, GALLUP, NM 87301-5748
(505) 722-1000
Mailing address
1610 MONTEREY DR, GALLUP, NM 87301-5640
(505) 722-9444

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
48391341205
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
168477
AZ
05
33089281
NM
Enumeration date
08/02/2006
Last updated
10/31/2011
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