Basic Information
| Provider Information | |||||||||
| NPI: | 1891954533 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | AILEIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ANDERSEN | ||||||||
| OtherFirstName: | HEATHER | ||||||||
| OtherMiddleName: | AILEIN | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | D.O. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 11398 BANDERA RD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782506840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129474180 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11398 BANDERA RD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782506840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105437334 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2008 | ||||||||
| LastUpdateDate: | 09/05/2012 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | P4335 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.