Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 217109 | MA |
N | 207T00000X | Neurosurgeon | FTL 42013 | TX |
Y | 207T00000X | Neurosurgeon | K6051 | TX |
NPI | 1043292550 |
---|---|
Provider Name | Dong H Kim |
First Address | Houston, TX 77030-1541 |
Second Address | Houston, TX 77030-1521 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2005 |
Last Update Date | 03/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
124967405 | (05) | TX |
124967406 | (05) | TX |
G48413 | (02) |