Provider Demographics
NPI:1154424364
Name:KIM, NAM H
Entity type:Individual
Prefix:
First Name:NAM
Middle Name:H
Last Name:KIM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 E 4TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-5100
Mailing Address - Country:US
Mailing Address - Phone:432-331-9900
Mailing Address - Fax:855-505-1212
Practice Address - Street 1:605 E 4TH ST STE 201
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5100
Practice Address - Country:US
Practice Address - Phone:855-505-1212
Practice Address - Fax:855-505-1212
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6343207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0053CUOtherBCBS OF TX PROVIDER #
TXH6343OtherPHYSICIAN LICENSE
TX131213405Medicaid
TX0053CUOtherBCBS OF TX PROVIDER #
TXH6343OtherPHYSICIAN LICENSE
TX131213405Medicaid
TX043654558OtherEIN