Provider Demographics
NPI:1881887867
Name:DART, KIMI L (DO)
Entity type:Individual
Prefix:DR
First Name:KIMI
Middle Name:L
Last Name:DART
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:215 OAK DR S STE E
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5617
Mailing Address - Country:US
Mailing Address - Phone:979-258-5445
Mailing Address - Fax:979-258-6030
Practice Address - Street 1:215 OAK DR S STE E
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5617
Practice Address - Country:US
Practice Address - Phone:979-258-5445
Practice Address - Fax:979-258-6030
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017258207YS0123X
TXP6804207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX288444YLZSMedicare PIN