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1912175951

NPI Code Detail

MEDICARE: DR. SEUNG KWON KIM MD

MEDICARE: DR. SEUNG KWON 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	2085R0202X	Diagnostic Radiology Physician	2012003526	MO
2	2085R0202X	Diagnostic Radiology Physician	V4693	TX
3	2085R0204X	Vascular & Interventional Radiology Physician	2012003526	MO
4	2085R0204X	Vascular & Interventional Radiology Physician	V4693	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912175951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEUNG KWON KIM MD

Provider Business Mailing Address
First Line	:	PO BOX 845347
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-5347
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5323 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-7201
Country	:	US
Telephone Number	:	214-645-8920
Fax Number	:

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

Provider Enumeration Date	:	02/12/2008
Last Update Date	:	03/17/2026

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Directions to “ DR. SEUNG KWON KIM MD” Practice Location

Language	Start Address	Practice Location

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