Basic Information
| Provider Information | |||||||||
| NPI: | 1437470515 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | HANNAH | ||||||||
| MiddleName: | ROSS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3803 ROBERT PORCHER WAY | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274102191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362863442 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3803 ROBERT PORCHER WAY | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274102191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362863442 | ||||||||
| FaxNumber: | 3362861156 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2010 | ||||||||
| LastUpdateDate: | 09/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2013-01461 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.