Provider Demographics
NPI:1942404728
Name:KIM, BILLY JOHN (MD)
Entity Type:Individual
Prefix:
First Name:BILLY
Middle Name:JOHN
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 1:410 42ND AVE N STE 400
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-3658
Mailing Address - Country:US
Mailing Address - Phone:615-329-7887
Mailing Address - Fax:615-346-6225
Practice Address - Street 1:660 S MOUNT JULIET RD STE 230
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3923
Practice Address - Country:US
Practice Address - Phone:615-874-9667
Practice Address - Fax:615-871-9682
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN460352086S0129X, 2086S0129X
NY247782-1390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
BP2-0019172OtherINSTITUTIONAL PERMIT