MEDICARE: DONG SOO KIM M.D.

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	174400000X	Specialist	G1689	TX

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	:	1487724720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONG SOO KIM M.D.

Provider Business Mailing Address
First Line	:	15 VILLAGE OAKS LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-6535
Country	:	US
Telephone Number	:	713-647-7844
Fax Number	:

Provider Business Practice Location Address
First Line	:	6500 NORTH FWY
Second Line	:	SUITE 116
City	:	HOUSTON
State	:	TX
Zip	:	77076-2941
Country	:	US
Telephone Number	:	713-697-7056
Fax Number	:	713-697-6199

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

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	07/08/2010

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Directions to “ DONG SOO KIM M.D.” Practice Location

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