Provider Demographics
NPI:1770210973
Name:KIM, KYLE
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3313 PACOLET DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-6035
Mailing Address - Country:US
Mailing Address - Phone:919-909-5717
Mailing Address - Fax:
Practice Address - Street 1:3313 PACOLET DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-6035
Practice Address - Country:US
Practice Address - Phone:919-909-5717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-07
Last Update Date:2022-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program