Provider Demographics
NPI:1073014114
Name:FAIRVIEW DERMATOLOGY PLLC
Entity Type:Organization
Organization Name:FAIRVIEW DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM-JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-397-3957
Mailing Address - Street 1:331 TOWN PL
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75069-1825
Mailing Address - Country:US
Mailing Address - Phone:314-397-3957
Mailing Address - Fax:
Practice Address - Street 1:331 TOWN PL
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:TX
Practice Address - Zip Code:75069-1825
Practice Address - Country:US
Practice Address - Phone:636-532-0990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-23
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty