MEDICARE: DR. PATRICK S 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	207L00000X	Anesthesiology Physician	2013009611	MO
2	207L00000X	Anesthesiology Physician	80002-020	WI
3	207L00000X	Anesthesiology Physician	37638	OK
4	207L00000X	Anesthesiology Physician	67040	TN

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	:	1942463401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK S KIM M.D.

Provider Business Mailing Address
First Line	:	3961 OLD SPARTA RD
Second Line	:
City	:	COOKEVILLE
State	:	TN
Zip	:	38506-5951
Country	:	US
Telephone Number	:	636-579-8544
Fax Number	:

Provider Business Practice Location Address
First Line	:	3961 OLD SPARTA RD
Second Line	:
City	:	COOKEVILLE
State	:	TN
Zip	:	38506-5951
Country	:	US
Telephone Number	:	636-579-8544
Fax Number	:

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

Provider Enumeration Date	:	07/05/2008
Last Update Date	:	05/08/2026

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Directions to “ DR. PATRICK S KIM M.D.” Practice Location

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