Individual
STEPHEN JOOWHAN KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
815 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2224
(817) 321-0404
Mailing address
816 W CANNON ST, FORT WORTH, TX 76104-3146
(817) 321-0404
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
01066145A
IN
2085R0202X
Diagnostic Radiology Physician
Primary
V0445
TX
2085R0204X
Vascular & Interventional Radiology Physician
01066145A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01066145A
IN LICENSE
IN
05
—
20139730
—
IN
Enumeration date
06/27/2008
Last updated
06/21/2024
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