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General NPI Number Information
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NPI Number | 1154624260
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Entity Type | Organization
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Legal Business Name | AGMP
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Dates
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Enumeration Date | 12/10/2010
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Last Update Date | 12/10/2010
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Provider Practice Location Address
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Address Line | 5111B MARTIN AVE
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City | AUSTIN
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State | TX
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Zip | 78751-2118
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Country | US
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Telephone | 512-630-2467
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Fax | 888-335-3210
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Provider Business Mailing Address
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Address Line | 5111B MARTIN AVE
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City | AUSTIN
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State | TX
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Zip | 78751-2118
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Country | US
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Telephone | 512-630-2467
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Fax | 888-335-3210
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | THOMAS KIM
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Credential | MD, MPH
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Telephone | 512-630-2467
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | N5158
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD.024557
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | D0063651
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD.024557
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License Number State | LA
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Taxonomy #5
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | D0063651
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License Number State | MD
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Taxonomy #6
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | N5158
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License Number State | TX
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