Individual
GRACE KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
925 E SOUTHLAKE BLVD, SUITE 100, SOUTHLAKE, TX 76092
(817) 912-8800
Mailing address
1935 MEDICAL DISTRICT DR, DALLAS, TX 75235-7701
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
Q9401
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/03/2014
Last updated
03/25/2022
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