Kim, Mary T
Kim, Mary T is an sole proprietor health care provider with primary practice located at 1501 Kings Hwy , Shreveport LA 71103-4228. She recently has only one registered license in Allopathic & Osteopathic Physicians / Plastic and Reconstructive Surgery, which is considered as her primary health care specialty. Kim, Mary T can be contacted via phone (318) 675-6154.Contact Information
Primary practice address
1501 Kings Hwy
Shreveport LA 71103-4228
Phone: (318) 675-6154
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Plastic and Reconstructive Surgery | 2086S0122X | MD200563 | Louisiana |
Profile Details
| NPI number | 1033192828 |
|---|---|
| LBN Legal business name | Kim, Mary T |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Nov 25th, 2005 |
| Last updated | May 18th, 2009 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1033192828 | NPPES |
| Louisiana | MEDICAID | 1581518 |
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