Provider Demographics
NPI:1437187333
Name:KIM, MIN S (MD)
Entity Type:Individual
Prefix:DR
First Name:MIN
Middle Name:S
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 FOUNTAINDALE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-2948
Mailing Address - Country:US
Mailing Address - Phone:662-328-7391
Mailing Address - Fax:
Practice Address - Street 1:2520 5TH ST N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-2008
Practice Address - Country:US
Practice Address - Phone:662-244-2042
Practice Address - Fax:662-244-2041
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18592207R00000X
WV28242208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08105201Medicaid
MSP00900548OtherRR MEDICARE PTAN
MSP00900548OtherRR MEDICARE PTAN
H65466Medicare UPIN
MSP00254216OtherRAILROAD MEDICARE
MSH65466Medicare UPIN
MS08105201Medicaid
MS09014281Medicaid
302I118817Medicare PIN