Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213ES0103X | Foot & Ankle Surgery | 0636 | AZ |
Y | 213ES0103X | Foot & Ankle Surgery | 2359 | TX |
NPI | 1013971027 |
---|---|
Provider Name | Dr. Paul Jeong Kim |
First Address | Boston, MA 02241-8283 |
Second Address | Dallas, TX 75390-2113 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 08/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
952699 | (05) | AZ |