1902761315 NPI number — HYUN AH KIM

Table of content: HYUN AH KIM (NPI 1902761315)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902761315 NPI number — HYUN AH KIM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIM
Provider First Name:
HYUN AH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

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:
1902761315
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
37, HYOSEONGJUNGANG-GIL, NAM-GU
Provider Second Line Business Mailing Address:
105/1103
Provider Business Mailing Address City Name:
DAEGU
Provider Business Mailing Address State Name:
OTHER
Provider Business Mailing Address Postal Code:
42514
Provider Business Mailing Address Country Code:
KR
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3601 4TH ST STE 3A105
Provider Second Line Business Practice Location Address:
NEUROLOGY DEPARTMENT
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79430-0002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-743-2391
Provider Business Practice Location Address Fax Number:
806-743-5687
Provider Enumeration Date:
12/17/2025

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: 2084N0400X , with the licence number:  49005 , 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)





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