Provider Demographics
NPI:1285860643
Name:KIM, FADALIA D (MD)
Entity Type:Individual
Prefix:
First Name:FADALIA
Middle Name:D
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:624 S FLOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-4553
Mailing Address - Country:US
Mailing Address - Phone:405-226-9849
Mailing Address - Fax:
Practice Address - Street 1:2782 WASHINGTON DR STE 100
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-1013
Practice Address - Country:US
Practice Address - Phone:405-400-1152
Practice Address - Fax:405-217-4383
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK271332084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200287330BMedicaid