MEDICARE: JOOHO PETER KIM MD

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	207RP1001X	Pulmonary Disease Physician	2021010725	MO
2	207R00000X	Internal Medicine Physician	01098079A	IN
3	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	01098079A	IN
4	207R00000X	Internal Medicine Physician	2021010725	MO
5	207RP1001X	Pulmonary Disease Physician	01098079A	IN
6	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	2021010725	MO

General Provider Information

NPI Number	:	1205228723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOOHO PETER KIM MD

Provider Business Mailing Address
First Line	:	1400 US HIGHWAY 61 # H1521
Second Line	:
City	:	FESTUS
State	:	MO
Zip	:	63028-4100
Country	:	US
Telephone Number	:	636-933-5337
Fax Number	:	636-933-8090

Provider Business Practice Location Address
First Line	:	1400 US HIGHWAY 61 # H1521
Second Line	:
City	:	FESTUS
State	:	MO
Zip	:	63028-4100
Country	:	US
Telephone Number	:	636-933-5337
Fax Number	:	636-933-8090

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2015
Last Update Date	:	01/07/2026

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Directions to “ JOOHO PETER KIM MD” Practice Location

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