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Organization
HYETAE KIM, MD, PA
Active
Organization
HYETAE KIM, MD, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHAD HAGGERTON (BUSINESS OFFICE MGR.)
(432) 550-5300
Entity
Organization
Contact information
Practice address
1157 E 42ND ST, ODESSA, TX 79762-7723
(432) 550-5300
(432) 687-6299
Mailing address
1157 E 42ND ST, ODESSA, TX 79762-7723
(432) 550-5300
(432) 687-6299
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
K1852
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0017JK
BCBS GROUP NUMBER
TX
05
—
158174601
—
TX
Enumeration date
03/01/2007
Last updated
05/01/2008
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