Provider Demographics
NPI:1093756074
Name:KIM, THOMAS (MD, MPH)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 JUNIUS ST STE 300
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1602
Mailing Address - Country:US
Mailing Address - Phone:214-521-5191
Mailing Address - Fax:844-873-8643
Practice Address - Street 1:7535 E HAMPDEN AVE # 407
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-4838
Practice Address - Country:US
Practice Address - Phone:303-578-2702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5158207R00000X, 2084P0800X, 2084P0800X
CODR.00538792084P0800X, 2084P0800X
LAMD.0245572084P0800X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH77389Medicare UPIN
MD409220100Medicaid
MDH77389Medicare UPIN