Provider Demographics
NPI:1215972567
Name:KEVIN KIMM DO,PC
Entity type:Organization
Organization Name:KEVIN KIMM DO,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:641-228-5555
Mailing Address - Street 1:621 S ILLINOIS AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-5489
Mailing Address - Country:US
Mailing Address - Phone:641-494-3041
Mailing Address - Fax:641-494-3059
Practice Address - Street 1:1010 S GRAND AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:CHARLES CITY
Practice Address - State:IA
Practice Address - Zip Code:50616-3729
Practice Address - Country:US
Practice Address - Phone:641-228-5555
Practice Address - Fax:641-228-5556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty