Provider Demographics
NPI:1457507527
Name:KIM, CHARLES BRIAN (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:BRIAN
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9811 W CHARLESTON BLVD
Mailing Address - Street 2:#2640
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117
Mailing Address - Country:US
Mailing Address - Phone:702-258-7788
Mailing Address - Fax:702-258-7787
Practice Address - Street 1:8930 W SUNSET RD
Practice Address - Street 2:SUITE #300
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148
Practice Address - Country:US
Practice Address - Phone:702-258-7788
Practice Address - Fax:702-258-7787
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2021-10-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ILK50014282195208600000X
NV14791208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery