Provider Demographics
NPI:1154578854
Name:KIM, GRACE LIM (NP)
Entity type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:LIM
Last Name:KIM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:GRACE
Other - Middle Name:EUN-MI
Other - Last Name:LIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:18TH MEDICAL COMMAND
Mailing Address - Street 2:ATTN: EAMC-DCCS-QM (CREDENTIALING OFFICE)
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96205-0054
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18TH MEDICAL COMMAND
Practice Address - Street 2:ATTN: EAMC-DCCS-QM (CREDENTIALING OFFICE)
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96205-0054
Practice Address - Country:US
Practice Address - Phone:0118227-916-6027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12186363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily