Provider Demographics
NPI:1457640500
Name:KIM, THOMAS (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 MAE ANNE AVE STE 405
Mailing Address - Street 2:#5224
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-1859
Mailing Address - Country:US
Mailing Address - Phone:530-562-7768
Mailing Address - Fax:
Practice Address - Street 1:10121 PINE AVE
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4856
Practice Address - Country:US
Practice Address - Phone:530-587-6011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15737207P00000X
CA124929207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine