Individual
MARY T KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1501 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 675-6154
Mailing address
1501 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 675-6154
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
MD200563
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1581518
—
LA
Enumeration date
11/25/2005
Last updated
05/18/2009
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