Provider Demographics
NPI:1962378190
Name:KIM, EUN MYUNG (MS, RDN, LD)
Entity type:Individual
Prefix:
First Name:EUN MYUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 PRAIRIE DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-5564
Mailing Address - Country:US
Mailing Address - Phone:214-607-6551
Mailing Address - Fax:
Practice Address - Street 1:1345 PRAIRIE DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-5564
Practice Address - Country:US
Practice Address - Phone:214-607-6551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-14
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT92555133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered