Healthcare Provider Details

I. General information

NPI: 1710949458
Provider Name (Legal Business Name): VERONICA D KIM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 04/17/2025
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 N MASON RD DIV IM ENDOCRINOLOGY, STE 330
SAINT LOUIS MO
63141-6431
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-3500
  • Fax: 314-230-1119
Mailing address:
  • Phone: 314-362-3500
  • Fax: 314-230-1119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR3P85
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberR3P85
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: