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:
Health care specialties
| Specialty | Code | License # | 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 10 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| 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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