Provider Demographics
NPI:1710949458
Name:KIM, VERONICA D (MD)
Entity Type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:D
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:111 SAINT LUKES CENTER DR STE 44B
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3509
Mailing Address - Country:US
Mailing Address - Phone:314-205-1076
Mailing Address - Fax:314-205-6433
Practice Address - Street 1:111 SAINT LUKES CENTER DR STE 44B
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3509
Practice Address - Country:US
Practice Address - Phone:314-205-1926
Practice Address - Fax:314-205-1026
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3P85207R00000X
MOMDR3P85207RB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00237517OtherMEDICARE RAILROAD
MOE91628Medicare UPIN