NPIMap

Individual provider Active NPI

Kimiknu Mentore, MD

  • Internal Medicine Physician
  • Boise, ID
National Provider Identifier
1184128480
Registry record updated Oct 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2771058 Issued in ID
Practice address
5966 W Curtisian Ave
Boise, ID 83704-8801
Phone
(208) 302-5450
NPI assigned
Mar 21, 2018
Last updated
Oct 9, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NM
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X 2771058 ID Primary
Infectious Disease Physician 207RI0200X MD2024-0242 NM

Addresses

Primary practice location

5966 W Curtisian Ave
Boise, ID 83704-8801

Mailing address

PO Box 190930
Boise, ID 83719-0930
Phone (208) 367-5170

Other practice location 1

1 University of New Mexico
Msc10 5550
Albuquerque, NM 87131
Phone (505) 272-4461

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM, ID2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20241202003384 NM Practitioner - Infectious Disease 3678008471 Reassigns benefits to 1 organization
I20250724002783 ID Practitioner - Infectious Disease 3678008471 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Infectious Disease
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Unm Medical Group IncGroup PAC ID 4981795267, 1,052 clinicians

Practice addresses (Care Compare)

1055 N Curtis Rd
Boise, ID 83706-1309
Phone (208) 367-2121

2211 Lomas Blvd NE
Albuquerque, NM 87106-2719
Phone (505) 272-2111

3025 W Cherry LN
Meridian, ID 83642-8531

4300 E Flamingo Ave
Nampa, ID 83687-3138
Phone (208) 205-1000

4424 E Flamingo Ave
Nampa, ID 83687-9306

5966 W Curtisian Ave
Boise, ID 83704-8801
Phone (208) 302-5455

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Unm Medical Group, Inc. CurrentSince Nov 17, 2024 Accepting new patients
Saint Alphonsus Regional Medical Center Inc Current Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Aug 1, 2025 Accepting new patients
Unm Medical Group Inc CurrentSince Nov 17, 2024 Accepting new patients
Saint Alphonsus Regional Medical Center Inc Internal Medicine CurrentSince Aug 1, 2025 Accepting new patients
Unm Medical Group Inc PastSince May 1, 2022 Accepting new patients

Locations

5966 W Curtisian Ave
Boise, ID 83704
Phone (208) 302-5450

3025 W Cherry Ln
Ste B
Meridian, ID 83642
Phone (208) 302-6400

4300 E Flamingo Ave
Nampa, ID 83687
Phone (208) 367-6416

4424 E Flamingo Ave
Ste 210
Nampa, ID 83687
Phone (208) 302-2000

800 Bradbury Dr SE
Ste 116
Albuquerque, NM 87106
Phone (505) 272-1476

2211 Lomas Blvd NE
Unm, NM 87106
Phone (505) 272-1111

Interoperability endpoints

  • Direct secure messaging: kmentore4609282@direct.trinity-health.org

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1521590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759968000000",
    "number": "1184128480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 190930",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837190930",
            "telephone_number": "208-367-5170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5966 W CURTISIAN AVE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048801",
            "telephone_number": "208-302-5450"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 University of New Mexico",
            "address_2": "MSC10 5550",
            "address_purpose": "LOCATION",
            "city": "Albuquerque",
            "state": "NM",
            "postal_code": "87131",
            "country_code": "US",
            "telephone_number": "505-272-4461",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MENTORE",
        "first_name": "KIMIKNU",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-21",
        "last_updated": "2025-10-09",
        "certification_date": "2025-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NM",
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ID",
            "license": "2771058",
            "primary": true
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "NM",
            "license": "MD2024-0242",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.