MEDICARE: DR. DONALD H 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	207R00000X	Internal Medicine Physician	21721	OK
2	208VP0000X	Pain Medicine Physician	21721	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00262362	OTHER	OK	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1821035916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD H KIM M.D.

Provider Business Mailing Address
First Line	:	PO BOX 891977
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73189-1977
Country	:	US
Telephone Number	:	405-692-9977
Fax Number	:	405-691-6347

Provider Business Practice Location Address
First Line	:	2815 SW 119TH ST.
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-2605
Country	:	US
Telephone Number	:	405-692-9977
Fax Number	:	405-691-6347

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

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	09/10/2007

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