Provider Demographics
NPI:1164469219
Name:DONALD H KIM MD PC
Entity Type:Organization
Organization Name:DONALD H KIM MD PC
Other - Org Name:BETHESDA MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:H
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-692-9977
Mailing Address - Street 1:PO BOX 891977
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73189-1977
Mailing Address - Country:US
Mailing Address - Phone:405-692-9977
Mailing Address - Fax:405-691-6347
Practice Address - Street 1:10629 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-6200
Practice Address - Country:US
Practice Address - Phone:405-692-9977
Practice Address - Fax:405-691-6347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21721207R00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP00262362OtherRAILROAD MEDICARE #
OK064700062006OtherBCBS PROVIDER #
OK064700062006OtherBCBS PROVIDER #