Kristofferson, Ken Kim

Kristofferson, Ken Kim is an individual health care provider with primary practice located at 7420 Remcon Circle Bldg. A, El Paso TX 79912. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Surgical. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is his primary health care specialty. Kristofferson, Ken Kim can be contacted via phone (915) 532-8823.

Contact Information

Primary practice address
7420 Remcon Circle Bldg. A El Paso TX 79912
Phone: (915) 532-8823
Fax: (915) 532-5909
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA02936 Texas
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X PA02936 Texas

Profile Details

NPI number 1154341584
LBN Legal business name Kristofferson, Ken Kim
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 20th, 2006
Last updated Jun 17th, 2014 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1154341584 NPPES
Texas Other PA02936 PA LICENSE
Texas MEDICAID 192820202 PA LICENSE
Texas MEDICAID 76300323 PA LICENSE
Texas MEDICAID 192820203 PA LICENSE

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