Provider Demographics
NPI:1063594299
Name:KIM, CAROLYN (MD)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 W PARK DR STE 120
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-2034
Mailing Address - Country:US
Mailing Address - Phone:972-827-1130
Mailing Address - Fax:972-597-4290
Practice Address - Street 1:2005 WEST PARK DRIVE, SUITE 120
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-7506
Practice Address - Country:US
Practice Address - Phone:972-827-1130
Practice Address - Fax:972-597-4290
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239504207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology