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General NPI Number Information
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NPI Number | 1871555326
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Entity Type | Individual
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Provider Name | HENRY J KIM M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/03/2006
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Last Update Date | 04/18/2011
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Provider Practice Location Address
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Address Line | 58 ROY BEALL DRIVE
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City | LUVERNE
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State | AL
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Zip | 36049-7329
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Country | US
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Telephone | 334-335-1212
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Fax | 334-335-1217
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Provider Business Mailing Address
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Address Line | 101 HOSPITAL CIRCLE
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City | LUVERNE
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State | AL
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Zip | 36049-7329
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Country | US
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Telephone | 334-335-1212
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Fax | 334-335-1217
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 25MA02405700
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2080I0007X
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Taxonomy Name | Pediatric Clinical & Laboratory Immunology Physician
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License Number | MD.30559
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License Number State | AL
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