Provider Demographics
NPI:1447459011
Name:GOHN, KYM C (DO)
Entity type:Individual
Prefix:
First Name:KYM
Middle Name:C
Last Name:GOHN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3016 W. WACKERLY ST.
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6960
Mailing Address - Country:US
Mailing Address - Phone:989-631-6730
Mailing Address - Fax:989-631-4398
Practice Address - Street 1:3016 W. WACKERLY ST.
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6960
Practice Address - Country:US
Practice Address - Phone:989-631-6730
Practice Address - Fax:989-631-4398
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS015655207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology