Provider Demographics
NPI:1932151263
Name:YANCEY, KIM B (MD)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:B
Last Name:YANCEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-648-3300
Mailing Address - Fax:214-648-5553
Practice Address - Street 1:5939 HARRY HINES BLVD FL 4
Practice Address - Street 2:UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9191
Practice Address - Country:US
Practice Address - Phone:214-648-3300
Practice Address - Fax:214-648-5553
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2016-08-26
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Provider Licenses
StateLicense IDTaxonomies
TX41663207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186663401Medicaid
TX8J7416Medicare PIN
TX186663401Medicaid