Provider Demographics
NPI:1528074952
Name:KIM, BERNARD C (MD)
Entity type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:C
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3636 EXECUTIVE CENTER DR STE G70
Mailing Address - Street 2:SUITE 212
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:SUITE 212
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
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL87672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX517620OtherVALUE OPTIONS PROVIDER ID
TX612688Medicare PIN
TXI16429Medicare UPIN
TX8C2419Medicare PIN
TX8D1863Medicare PIN