Healthcare Provider Details

I. General information

NPI: 1588005672
Provider Name (Legal Business Name): YUN W KIM, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2013
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11207 N LAMAR BLVD STE B
AUSTIN TX
78753-3056
US

IV. Provider business mailing address

11207 N LAMAR BLVD STE B
AUSTIN TX
78753-3056
US

V. Phone/Fax

Practice location:
  • Phone: 512-649-2195
  • Fax: 512-814-0726
Mailing address:
  • Phone: 512-649-2195
  • Fax: 512-814-0726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberP4470
License Number StateTX

VIII. Authorized Official

Name: MARIAH E BARNES
Title or Position: OFFICE MANAGER
Credential:
Phone: 512-472-3161