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NPI Code Detail

MEDICARE: DR. IAN KIM MD

MEDICARE: DR. IAN 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
1261QU0200XUrgent Care Clinic/Center
2207Q00000XFamily Medicine Physician9400542NC
32084A0401XAddiction Medicine (Psychiatry & Neurology) Physician9400542NC

General Provider Information

NPI Number : 1366594293
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. IAN KIM MD
Provider Business Mailing Address
First Line : 213 CATTLE RIDGE RD
Second Line :
City : WAXHAW
State : NC
Zip : 28173-6843
Country : US
Telephone Number : 704-975-9636
Fax Number :
Provider Business Practice Location Address
First Line : 1895 E DIXON BLVD
Second Line :
City : SHELBY
State : NC
Zip : 28152-6901
Country : US
Telephone Number : 800-805-6989
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2007
Last Update Date : 07/07/2023

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