Individual
HAE KYONG KIM NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
200 PATEWOOD DR, SUITE A120, GREENVILLE, SC 29615-3593
(864) 454-2670
(864) 454-2679
Mailing address
1 INDEPENDENCE PT, SUITE 212, GREENVILLE, SC 29615-4545
(864) 797-6044
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
20480
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
204807
—
SC
01
—
370017229
RR MEDICARE
SC
01
—
3816691
CIGNA ID
SC
01
—
571004971024
BCBS OF SC ID
SC
01
—
571004971027
BLUECHOICE HEALTHPLAN ID
SC
01
—
7744166
AETNA ID
SC
Enumeration date
06/15/2006
Last updated
01/08/2013
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