Provider Demographics
NPI:1992389068
Name:GREATER TEXAS FOOT & ANKLE SPECIALIST LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:GREATER TEXAS FOOT & ANKLE SPECIALIST LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:DONGHYUN
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:469-384-2135
Mailing Address - Street 1:12500 LEBANON RD STE 104
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-9474
Mailing Address - Country:US
Mailing Address - Phone:469-384-2135
Mailing Address - Fax:469-252-1064
Practice Address - Street 1:12500 LEBANON RD STE 104
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-9474
Practice Address - Country:US
Practice Address - Phone:469-384-2135
Practice Address - Fax:469-252-1064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-05
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty