1649594268 NPI number — DR. STEVEN KIM M.D.

Table of content: DR. STEVEN KIM M.D. (NPI 1649594268)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649594268 NPI number — DR. STEVEN KIM M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIM
Provider First Name:
STEVEN
Provider Middle Name:
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:
1649594268
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1521 COOPER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76104-2711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-336-5864
Provider Business Mailing Address Fax Number:
817-336-2159

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8752 MEDICAL CITY WAY STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76177-2497
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-284-9225
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/25/2010

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: 207RC0200X , with the licence number:  Q7903 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: Q7903 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: Q7903 . This is a "TEXAS MEDICAL LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8JE39 . This is a "BCBSTX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 358895601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 358895602 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 358895603 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8JE040 . This is a "BCBSTX - WCCA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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