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General NPI Number Information
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NPI Number | 1962486647
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Entity Type | Individual
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Provider Name | ROBERT S KIM M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/06/2005
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Last Update Date | 03/02/2012
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Provider Practice Location Address
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Address Line | 6000 EARLE BROWN DR
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City | BROOKLYN CENTER
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State | MN
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Zip | 55430-2506
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Country | US
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Telephone | 952-993-4900
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Fax |
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Provider Business Mailing Address
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Address Line | 3800 PARK NICOLLET BLVD CREDENTIALING
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-2527
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Country | US
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Telephone |
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 31105
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License Number State | MN
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