Provider Demographics
NPI:1437470515
Name:KIM, HANNAH ROSS (DO)
Entity Type:Individual
Prefix:DR
First Name:HANNAH
Middle Name:ROSS
Last Name:KIM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3803 ROBERT PORCHER WAY
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-2191
Mailing Address - Country:US
Mailing Address - Phone:336-286-3442
Mailing Address - Fax:
Practice Address - Street 1:3803 ROBERT PORCHER WAY
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-2191
Practice Address - Country:US
Practice Address - Phone:336-286-3442
Practice Address - Fax:336-286-1156
Is Sole Proprietor?:No
Enumeration Date:2010-06-12
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-01461207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine