Provider Demographics
NPI:1124139506
Name:PONDWORKS PA
Entity type:Organization
Organization Name:PONDWORKS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-371-9555
Mailing Address - Street 1:3636 EXECUTIVE CENTER DR STE G70
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-1628
Mailing Address - Country:US
Mailing Address - Phone:512-371-9555
Mailing Address - Fax:512-367-5756
Practice Address - Street 1:3636 EXECUTIVE CENTER DR STE G70
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-1628
Practice Address - Country:US
Practice Address - Phone:512-371-9555
Practice Address - Fax:512-367-5756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL87672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty