Provider Demographics
NPI:1982894424
Name:BABIANO M. S. KIM, M. D., P.C.
Entity Type:Organization
Organization Name:BABIANO M. S. KIM, M. D., P.C.
Other - Org Name:N/A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:BABIANO
Authorized Official - Middle Name:MS
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-295-1842
Mailing Address - Street 1:21210 GODDARD RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-4264
Mailing Address - Country:US
Mailing Address - Phone:313-295-1842
Mailing Address - Fax:313-295-1932
Practice Address - Street 1:21210 GODDARD RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-4264
Practice Address - Country:US
Practice Address - Phone:313-295-1842
Practice Address - Fax:313-295-1932
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:N/A
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-31
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301044759208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1565670Medicaid
MI0P12070Medicare PIN
MI1565670Medicaid