Provider Demographics
NPI:1285987156
Name:DAVID H KIM DO LLC
Entity type:Organization
Organization Name:DAVID H KIM DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:419-621-7620
Mailing Address - Street 1:703 TYLER ST
Mailing Address - Street 2:SUITE 351
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-3367
Mailing Address - Country:US
Mailing Address - Phone:419-621-7620
Mailing Address - Fax:419-621-7623
Practice Address - Street 1:703 TYLER ST
Practice Address - Street 2:SUITE 351
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-3367
Practice Address - Country:US
Practice Address - Phone:419-621-7620
Practice Address - Fax:419-621-7623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH340082212086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2460537Medicaid
OHH072640Medicare UPIN