MEDICARE: DR. KEEMBERLY 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	207N00000X	Dermatology Physician	V1155	TX

General Provider Information

NPI Number	:	1215497797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEEMBERLY KIM MD

Provider Business Mailing Address
First Line	:	2132 BISSONNET ST STE 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-1508
Country	:	US
Telephone Number	:	281-203-0600
Fax Number	:	281-205-3505

Provider Business Practice Location Address
First Line	:	2132 BISSONNET ST STE 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-1508
Country	:	US
Telephone Number	:	281-203-0600
Fax Number	:	281-205-3505

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

Provider Enumeration Date	:	03/21/2019
Last Update Date	:	07/08/2024

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