Provider Demographics
NPI:1326292517
Name:FELLMAN, KIM-NGAN P (MD)
Entity Type:Individual
Prefix:
First Name:KIM-NGAN
Middle Name:P
Last Name:FELLMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12221 MERIT DRIVE
Mailing Address - Street 2:SUITE 910
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251
Mailing Address - Country:US
Mailing Address - Phone:469-374-3850
Mailing Address - Fax:469-374-3851
Practice Address - Street 1:840 MONTCLAIR RD
Practice Address - Street 2:SUITE 317
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-1920
Practice Address - Country:US
Practice Address - Phone:205-592-5135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXN6292207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program