Provider Demographics
NPI:1043283401
Name:KIM, DAVID H (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:H
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 1:6100 W 96TH ST STE 125
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-6006
Mailing Address - Country:US
Mailing Address - Phone:317-715-1800
Mailing Address - Fax:317-715-6200
Practice Address - Street 1:6100 W 96TH ST STE 125
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-6006
Practice Address - Country:US
Practice Address - Phone:317-715-1800
Practice Address - Fax:317-715-6200
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057249A2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200419910Medicaid
IL01Medicaid
IN194870GMedicare ID - Type Unspecified
IN200419910Medicaid