Provider Demographics
NPI:1740483288
Name:KIM, JONATHAN T (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:T
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1331 W GRAND PKWY N STE 235
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-2710
Mailing Address - Country:US
Mailing Address - Phone:346-510-4800
Mailing Address - Fax:346-241-4540
Practice Address - Street 1:1331 W GRAND PKWY N STE 235
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-2710
Practice Address - Country:US
Practice Address - Phone:346-510-4800
Practice Address - Fax:346-241-4540
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN5777207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN5777OtherPHYSICIAN PERMIT