Provider Demographics
NPI:1366638819
Name:SEONG CHEOL KIM, MD, PA
Entity Type:Organization
Organization Name:SEONG CHEOL KIM, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:SEONG
Authorized Official - Middle Name:CHEOL
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-660-2533
Mailing Address - Street 1:PO BOX 851978
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75185-1978
Mailing Address - Country:US
Mailing Address - Phone:214-660-2533
Mailing Address - Fax:214-660-2525
Practice Address - Street 1:1012 N GALLOWAY AVE STE 102
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-2461
Practice Address - Country:US
Practice Address - Phone:214-660-2533
Practice Address - Fax:214-660-2525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141014404Medicaid
TX141014404Medicaid