MEDICARE: KITAE KIM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0102X	Surgical Critical Care Physician	11567	NV
2	208600000X	Surgery Physician	11567	NV

General Provider Information

NPI Number	:	1033188289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KITAE KIM MD

Provider Business Mailing Address
First Line	:	2657 WINDMILL PKWY # 685
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-3384
Country	:	US
Telephone Number	:	702-629-3771
Fax Number	:	702-438-6666

Provider Business Practice Location Address
First Line	:	3061 S MARYLAND PKWY STE 104
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-6226
Country	:	US
Telephone Number	:	702-629-3771
Fax Number	:	702-438-6666

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	07/27/2022

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Directions to “ KITAE KIM MD” Practice Location

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