Provider Demographics
NPI:1275671414
Name:KIM, BRYAN (MD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:
Last Name:KIM
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 ALBANY ST
Mailing Address - Street 2:
Mailing Address - City:BEECH GROVE
Mailing Address - State:IN
Mailing Address - Zip Code:46107-1555
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1500 ALBANY ST
Practice Address - Street 2:
Practice Address - City:BEECH GROVE
Practice Address - State:IN
Practice Address - Zip Code:46107-1555
Practice Address - Country:US
Practice Address - Phone:317-532-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD198618207R00000X, 2083C0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083C0008XAllopathic & Osteopathic PhysiciansPreventive MedicineClinical Informatics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500780839Medicaid