Healthcare Provider Details

I. General information

NPI: 1821334962
Provider Name (Legal Business Name): WILLIAM KIM, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5980 S RAINBOW BLVD STE 100
LAS VEGAS NV
89118-4202
US

IV. Provider business mailing address

5980 S RAINBOW BLVD STE 100
LAS VEGAS NV
89118-4202
US

V. Phone/Fax

Practice location:
  • Phone: 702-765-7246
  • Fax: 702-765-7227
Mailing address:
  • Phone: 702-765-7246
  • Fax: 702-765-7227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number6486
License Number StateNV

VIII. Authorized Official

Name: WILLIAM KIM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 702-765-7246