Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 31577 | OK |
NPI | 1003000597 |
---|---|
Provider Name | Dr. Dae Y Kim |
First Address | Tulsa, OK 74104-4000 |
Second Address | Tulsa, OK 74104-4000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2007 |
Last Update Date | 15/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
324649801 (MDACC) | (05) | TX |
8EB319 (MDACC) | BCBS (01) | TX |