Healthcare Provider Details

I. General information

NPI: 1861765083
Provider Name (Legal Business Name): DAVID DAE WE KIM D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2012
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 W WOOSTER ST SUITE 129
BOWLING GREEN OH
43402
US

IV. Provider business mailing address

970 W WOOSTER ST SUITE 129
BOWLING GREEN OH
43402-2652
US

V. Phone/Fax

Practice location:
  • Phone: 419-728-0640
  • Fax:
Mailing address:
  • Phone: 419-728-0640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number34013505
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2024-03137
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: