Provider Demographics
NPI:1548203748
Name:REYES, KIM MARIE (MD)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:MARIE
Last Name:REYES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 S VAL VISTA DR STE A3-239A3
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-1374
Mailing Address - Country:US
Mailing Address - Phone:818-378-3978
Mailing Address - Fax:
Practice Address - Street 1:1180 NEWFIELD AVE
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-1409
Practice Address - Country:US
Practice Address - Phone:314-888-5233
Practice Address - Fax:203-590-8644
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50309207V00000X
CT06221207V00000X, 208D00000X
CAG71574207V00000X
VA0101266425207V00000X, 208D00000X
NY274956207V00000X, 208D00000X
NMMD2015-0941207V00000X
PAMD461619208D00000X
TXR0309208D00000X
AZ49440208D00000X
CAG071574208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G715742Medicaid
NM02223040Medicaid
NM02223040Medicaid
NM507525YS5YMedicare PIN