Healthcare Provider Details

I. General information

NPI: 1902761315
Provider Name (Legal Business Name): HYUN AH KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 4TH S NEUROLOGY DEPARTMENT
LUBBOCK TX
79430-0001
US

IV. Provider business mailing address

37, HYOSEONGJUNGANG-GIL, NAM-GU 105/1103
DAEGU OTHER
42514
KR

V. Phone/Fax

Practice location:
  • Phone: 806-743-2391
  • Fax: 806-743-2391
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: