Individual
BOO KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1901 S 1ST ST, TEMPLE, TX 76504-7451
(254) 743-2783
Mailing address
11414 SOMERVILLE, TEMPLE, TX 76502-6405
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
F7804
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F7804
MEDICAL LICENCE
TX
Enumeration date
08/25/2006
Last updated
07/08/2007
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