Healthcare Provider Details

I. General information

NPI: 1235838350
Provider Name (Legal Business Name): JOHN KIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 09/01/2024
Certification Date: 09/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 ROGER BROOKE DR SAMMC, MCHE-ZDM-M, INTERNAL MEDICINE RESIDENCY
JBSA-FORT SAM HOUSTON TX
78234-4504
US

IV. Provider business mailing address

3551 ROGER BROOKE DR SAMMC, MCHE-ZDM-M, INTERNAL MEDICINE RESIDENCY
JBSA-FORT SAM HOUSTON TX
78234-4504
US

V. Phone/Fax

Practice location:
  • Phone: 210-916-5000
  • Fax: 210-916-2077
Mailing address:
  • Phone: 210-916-5000
  • Fax: 210-916-2077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberV3350
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: