Provider Demographics
NPI:1093329021
Name:KIM, KWANG HYUN (APN)
Entity type:Individual
Prefix:
First Name:KWANG
Middle Name:HYUN
Last Name:KIM
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 S SHEPHERD DR APT 617
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-3639
Mailing Address - Country:US
Mailing Address - Phone:832-837-9556
Mailing Address - Fax:
Practice Address - Street 1:2675 S ABILENE ST STE 100
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2363
Practice Address - Country:US
Practice Address - Phone:720-507-4779
Practice Address - Fax:833-941-5047
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139147363LP2300X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care