Basic Information
| Provider Information | |||||||||
| NPI: | 1437187333 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | MIN | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 35 FOUNTAINDALE | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | MS | ||||||||
| PostalCode: | 397052948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6623287391 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2520 5TH ST N | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | MS | ||||||||
| PostalCode: | 397052008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6622442042 | ||||||||
| FaxNumber: | 6622442041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 07/02/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 18592 | MS | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 28242 | WV | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 08105201 | 05 | MS | MEDICAID |