Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 12344 | ND |
NPI | 1003077769 |
---|---|
Provider Name | Charles Kim |
First Address | Lubbock, TX 79416-5965 |
Second Address | Lubbock, TX 79430-0002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2008 |
Last Update Date | 20/01/2022 |