MEDICARE: DAVID H KIM, MD, PROF. CORP.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	9568	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	38048	OTHER	NV	MEDICARE, GROUP
3	38049	OTHER	NV	MEDICARE, INDIVIDUAL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134302771
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID H KIM, MD, PROF. CORP.

Provider Business Mailing Address
First Line	:	5380 S RAINBOW BLVD STE 310
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-1880
Country	:	US
Telephone Number	:	702-939-1600
Fax Number	:

Provider Business Practice Location Address
First Line	:	5380 S RAINBOW BLVD STE 310
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-1880
Country	:	US
Telephone Number	:	702-939-1600
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID H KIM
Credential	:	MD
Telephone Number	:	702-939-1600

Provider Enumeration Date	:	12/05/2007
Last Update Date	:	12/05/2007

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