Provider Demographics
NPI:1649360272
Name:TAYLOR, KIM Y (MD)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:Y
Last Name:TAYLOR
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 1:4400 S 700 E # 240
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3053
Mailing Address - Country:US
Mailing Address - Phone:801-264-4464
Mailing Address - Fax:
Practice Address - Street 1:4400 S 700 E
Practice Address - Street 2:240
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-3053
Practice Address - Country:US
Practice Address - Phone:801-264-4464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT146625-1205207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology