Healthcare Provider Details

I. General information

NPI: 1679519771
Provider Name (Legal Business Name): ROBIN DAVIS KIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ROBIN DAVIS KIM

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N 1900 E
SALT LAKE CITY UT
84132-0002
US

IV. Provider business mailing address

30 N 1900 E SOM 3B110
SALT LAKE CITY UT
84132-0002
US

V. Phone/Fax

Practice location:
  • Phone: 801-585-6140
  • Fax: 801-587-9370
Mailing address:
  • Phone: 801-585-6140
  • Fax: 801-587-9370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number7740089-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: