Provider Demographics
NPI:1457595530
Name:KIM, CAROLINE (MD)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 GREENHOUSE RD
Mailing Address - Street 2:STE 1800
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-7855
Mailing Address - Country:US
Mailing Address - Phone:713-464-2100
Mailing Address - Fax:281-392-2032
Practice Address - Street 1:2222 GREENHOUSE RD
Practice Address - Street 2:STE 1800
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-7855
Practice Address - Country:US
Practice Address - Phone:713-464-2100
Practice Address - Fax:281-392-2032
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR73633208600000X
TXQ5456208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8GD854OtherBCBS
TX8FK026OtherBLUE CROSS BLUE SHIELD
TX351674201Medicaid
TX8GD854OtherBCBS
TX8FK026OtherBLUE CROSS BLUE SHIELD