Provider Demographics
NPI:1629356845
Name:KIM, NICHOLAS K (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:K
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 1:1015 NORTHWESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIS JUNCTION
Mailing Address - State:IL
Mailing Address - Zip Code:61020-9719
Mailing Address - Country:US
Mailing Address - Phone:815-762-5750
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF KANSAS MEDICAL CTR
Practice Address - Street 2:3901 RAINBOW BLVD
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-0001
Practice Address - Country:US
Practice Address - Phone:913-588-3283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-22
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program