Provider Demographics
NPI:1346828225
Name:DR KIM DERMATOLOGY PLLC
Entity Type:Organization
Organization Name:DR KIM DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BILLET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-922-3376
Mailing Address - Street 1:4645 AVON LN STE 375
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-1216
Mailing Address - Country:US
Mailing Address - Phone:469-922-3376
Mailing Address - Fax:469-922-3222
Practice Address - Street 1:4645 AVON LN STE 375
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-1216
Practice Address - Country:US
Practice Address - Phone:469-922-3376
Practice Address - Fax:469-922-3222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty