Provider Demographics
NPI:1306233291
Name:NORTH REGIONAL INFECTIOUS DISEASES PROFESSIONAL ASSOCIATION
Entity type:Organization
Organization Name:NORTH REGIONAL INFECTIOUS DISEASES PROFESSIONAL ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SEONG CHEOL
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-955-0145
Mailing Address - Street 1:PO BOX 851978
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75185-1978
Mailing Address - Country:US
Mailing Address - Phone:972-955-0145
Mailing Address - Fax:214-660-2525
Practice Address - Street 1:1730 LAKE FOREST DR
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-3342
Practice Address - Country:US
Practice Address - Phone:972-955-0145
Practice Address - Fax:214-660-2525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9585207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty