Provider Demographics
NPI:1144809534
Name:NGO, JOSEPHINE KIM (PA-C)
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:KIM
Last Name:NGO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-2412
Mailing Address - Fax:970-429-4173
Practice Address - Street 1:100 COOK ST STE 406
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5340
Practice Address - Country:US
Practice Address - Phone:720-516-9417
Practice Address - Fax:720-516-9445
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2024-06-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE2602363A00000X
COPA.0008045363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical