Basic Information
| Provider Information | |||||||||
| NPI: | 1730150483 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VO | ||||||||
| FirstName: | KIM | ||||||||
| MiddleName: | VAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 204 COWDRAY PARK | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292238128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037360963 | ||||||||
| FaxNumber: | 8037360963 | ||||||||
| Practice Location | |||||||||
| Address1: | 3511 MEDICAL DR | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292036504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037710518 | ||||||||
| FaxNumber: | 8037717286 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2006 | ||||||||
| LastUpdateDate: | 02/09/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 10735 | SC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.