Provider Demographics
NPI:1992905376
Name:KIM, JOSEPH M (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
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 1:1020 FLOWER MOUND RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-3440
Mailing Address - Country:US
Mailing Address - Phone:972-410-0042
Mailing Address - Fax:972-410-0044
Practice Address - Street 1:1020 FLOWER MOUND RD STE 100
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-3440
Practice Address - Country:US
Practice Address - Phone:972-410-0042
Practice Address - Fax:972-410-0044
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2023-10-04
Deactivation Date:2022-12-04
Deactivation Code:
Reactivation Date:2022-12-20
Provider Licenses
StateLicense IDTaxonomies
IL036-125975207Q00000X
TXQ0085207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036125975Medicaid
IL256510062Medicare PIN