Provider Demographics
NPI:1588699284
Name:KIM, PAUL K (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:K
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 HOSPITAL PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-5935
Mailing Address - Country:US
Mailing Address - Phone:817-354-2680
Mailing Address - Fax:817-510-5927
Practice Address - Street 1:1615 HOSPITAL PKWY STE 103
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-5935
Practice Address - Country:US
Practice Address - Phone:817-354-2680
Practice Address - Fax:817-510-5927
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7035207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123677001Medicaid
TX123677001Medicaid
TXF83843Medicare UPIN