1508906132 NPI number — DR. GEORGE GI-MIN KIM M.D.

Table of content: DR. GEORGE GI-MIN KIM M.D. (NPI 1508906132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508906132 NPI number — DR. GEORGE GI-MIN KIM M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIM
Provider First Name:
GEORGE
Provider Middle Name:
GI-MIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508906132
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 219
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28750-0219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-859-7659
Provider Business Mailing Address Fax Number:
828-859-2470

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2536 LYNN RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
TRYON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28782-7875
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-859-7659
Provider Business Practice Location Address Fax Number:
828-859-2470
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  9700614 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 891061Y , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00243621 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1061Y . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: N0061D , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com