Provider Demographics
NPI:1376959700
Name:KIM, DAE SIK ALEX (DPM)
Entity Type:Individual
Prefix:
First Name:DAE SIK
Middle Name:ALEX
Last Name:KIM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 LITTLE ELM PKWY STE 803
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-1920
Mailing Address - Country:US
Mailing Address - Phone:469-430-9987
Mailing Address - Fax:
Practice Address - Street 1:2601 LITTLE ELM PKWY STE 803
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-1920
Practice Address - Country:US
Practice Address - Phone:469-430-9987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00344400213ES0103X
TX2263213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery