Healthcare Provider Details

I. General information

NPI: 1164469219
Provider Name (Legal Business Name): DONALD H KIM MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10629 S WESTERN AVE
OKLAHOMA CITY OK
73170-6200
US

IV. Provider business mailing address

PO BOX 891977
OKLAHOMA CITY OK
73189-1977
US

V. Phone/Fax

Practice location:
  • Phone: 405-692-9977
  • Fax: 405-691-6347
Mailing address:
  • Phone: 405-692-9977
  • Fax: 405-691-6347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number21721
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number21721
License Number StateOK

VIII. Authorized Official

Name: DR. DONALD H KIM
Title or Position: PRESIDENT
Credential: MD
Phone: 405-692-9977