Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | M1186 | TX |
NPI | 1013963156 |
---|---|
Provider Name | Ronald S. Kim |
First Address | Austin, TX 78732-2040 |
Second Address | Austin, TX 78705-2703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8M6676 | BC/BS (01) | TX |
I31595 | (02) | TX |