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General NPI Number Information
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NPI Number | 1306233291
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Entity Type | Organization
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Legal Business Name | NORTH REGIONAL INFECTIOUS DISEASES PROFESSIONAL ASSOCIATION
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Dates
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Enumeration Date | 04/20/2015
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Last Update Date | 04/20/2015
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Provider Practice Location Address
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Address Line | 1730 LAKE FOREST DR
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City | ROCKWALL
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State | TX
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Zip | 75087-3342
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Country | US
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Telephone | 972-955-0145
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Fax | 214-660-2525
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Provider Business Mailing Address
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Address Line | PO BOX 851978
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City | MESQUITE
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State | TX
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Zip | 75185-1978
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Country | US
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Telephone | 972-955-0145
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Fax | 214-660-2525
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DAVID SEONG CHEOL KIM
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Credential | MD
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Telephone | 972-955-0145
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | K9585
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License Number State | TX
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