Basic Information
| Provider Information | |||||||||
| NPI: | 1942404728 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | BILLY | ||||||||
| MiddleName: | JOHN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 356 24TH AVE N STE 300 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372031569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153466213 | ||||||||
| FaxNumber: | 6153466225 | ||||||||
| Practice Location | |||||||||
| Address1: | 3901 CENTRAL PIKE | ||||||||
| Address2: | SUITE 555 | ||||||||
| City: | HERMITAGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370763419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158749667 | ||||||||
| FaxNumber: | 6158719682 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2007 | ||||||||
| LastUpdateDate: | 05/31/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | M7332 | TX | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 390200000X | 247782-1 | NY | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2086S0129X | 46035 | TN | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | BP2-0019172 | 01 | INSTITUTIONAL PERMIT | OTHER |