Individual
JONG MOON KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12221 MERIT DR, SUITE 1610, DALLAS, TX 75251-2202
(214) 217-1911
Mailing address
13223 TORRINGTON DRIVE, FRISCO, TX 75035
(214) 577-2831
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
35.088399
OH
207P00000X
Emergency Medicine Physician
Primary
N0167
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000560036
ANTHEM
OH
05
—
195454703
—
TX
05
—
195454704
—
TX
05
—
2847807
—
OH
01
—
8BZ579
BCBS
TX
01
—
P00802534
RAILROAD
TX
Enumeration date
05/10/2007
Last updated
01/18/2013
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