Provider Demographics
NPI:1881934404
Name:KYM ORTHOPEDICS PLLC
Entity type:Organization
Organization Name:KYM ORTHOPEDICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:KYM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-746-2663
Mailing Address - Street 1:3316 4TH ST #4B
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-4405
Mailing Address - Country:US
Mailing Address - Phone:208-746-2663
Mailing Address - Fax:208-746-3390
Practice Address - Street 1:3316 4TH ST #4B
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-4405
Practice Address - Country:US
Practice Address - Phone:208-746-2663
Practice Address - Fax:208-746-3390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-19
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1881934404Medicaid
ID1881934404Medicaid