Provider Demographics
NPI:1376563403
Name:KIM, STEPHEN ALAN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ALAN
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7933 PRESTON RD
Mailing Address - Street 2:BE WELL HEALTH CENTER
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-2302
Mailing Address - Country:US
Mailing Address - Phone:972-403-6000
Mailing Address - Fax:972-403-6010
Practice Address - Street 1:3140 LEGACY DR STE 720
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-7917
Practice Address - Country:US
Practice Address - Phone:972-292-0256
Practice Address - Fax:972-403-9198
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2020-10-13
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Provider Licenses
StateLicense IDTaxonomies
TXM5796207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX191712201Medicaid
TXP00453506OtherRAILROAD MEDICARE
TXP00453506OtherRAILROAD MEDICARE