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General NPI Number Information
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NPI Number | 1316932601
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Entity Type | Individual
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Provider Name | MARVIN RENELL KYM MD
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Gender | Male
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Dates
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Enumeration Date | 09/13/2005
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Last Update Date | 07/19/2024
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Provider Practice Location Address
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Address Line | 2301 W A ST
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City | MOSCOW
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State | ID
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Zip | 83843-4042
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Country | US
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Telephone | 208-883-1135
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Fax | 208-892-0174
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Provider Business Mailing Address
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Address Line | PO BOX 8007
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City | MOSCOW
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State | ID
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Zip | 83843-0507
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Country | US
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Telephone | 208-882-4511
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Fax | 208-883-6580
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | WA0029535
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | M6029
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License Number State | ID
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