Provider Demographics
NPI:1356305833
Name:KIM, VICTOR B (MD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:B
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:PO BOX 896206
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-6206
Mailing Address - Country:US
Mailing Address - Phone:252-633-6730
Mailing Address - Fax:252-633-6740
Practice Address - Street 1:960 NEWMAN RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5200
Practice Address - Country:US
Practice Address - Phone:252-633-6730
Practice Address - Fax:252-633-6740
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400532208G00000X, 208600000X
MDD78369208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30205283Medicaid
NHI35036Medicare UPIN
NH30205283Medicaid
MEVX0875Medicare PIN
MERE8344Medicare PIN
MD372385YTQMedicare PIN