Provider Demographics
NPI:1679519771
Name:KIM, ROBIN DAVIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:DAVIS
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:DAVIS
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:30 N 1900 E
Mailing Address - Street 2:SOM 3B110
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-0002
Mailing Address - Country:US
Mailing Address - Phone:801-585-6140
Mailing Address - Fax:801-587-9370
Practice Address - Street 1:30 N 1900 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0002
Practice Address - Country:US
Practice Address - Phone:801-585-6140
Practice Address - Fax:801-587-9370
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7740089-1205204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273977100Medicaid
FL273977100Medicaid
FLI45091Medicare UPIN
FL28773ZMedicare PIN