Provider Demographics
NPI:1508805052
Name:KIM, DAVID D (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:D
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 1:4849 PAULSEN ST STE 312
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4426
Mailing Address - Country:US
Mailing Address - Phone:912-483-8817
Mailing Address - Fax:
Practice Address - Street 1:4849 PAULSEN ST STE 312
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4426
Practice Address - Country:US
Practice Address - Phone:912-483-8817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047336207WX0009X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000792932HOtherMEDICAID- VIDALIA
GA00792932BMedicaid
GA000792932FOtherMEDICAID - STATESBORO
GA1508805052OtherMEDICARE RAILROAD
782177OtherBLUE CROSS BLUE SHIELD
SCGPA977OtherMEDICAID GRP. SAV
GA00792932GOtherMEDICAID - SAVANNAH
GA511G701032OtherMEDICARE GROUP
782177OtherBLUE CROSS BLUE SHIELD
GA180037407Medicare PIN
GA41ZCDMQMedicare PIN
SCGPA977OtherMEDICAID GRP. SAV
GA1508805052OtherMEDICARE RAILROAD
GA0412940004Medicare NSC
782177OtherBLUE CROSS BLUE SHIELD
GA6150410005Medicare NSC
GA0412940007Medicare NSC
GA0412940001Medicare NSC
GA6150410004Medicare NSC
SCG47336Medicaid