Provider Demographics
NPI:1871555326
Name:KIM, HENRY J (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:J
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:101 HOSPITAL CIRCLE
Mailing Address - Street 2:
Mailing Address - City:LUVERNE
Mailing Address - State:AL
Mailing Address - Zip Code:36049-7329
Mailing Address - Country:US
Mailing Address - Phone:334-335-1212
Mailing Address - Fax:334-335-1217
Practice Address - Street 1:58 ROY BEALL DRIVE
Practice Address - Street 2:
Practice Address - City:LUVERNE
Practice Address - State:AL
Practice Address - Zip Code:36049-7329
Practice Address - Country:US
Practice Address - Phone:334-335-1212
Practice Address - Fax:334-335-1217
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02405700174400000X
ALMD.305592080I0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080I0007XAllopathic & Osteopathic PhysiciansPediatricsClinical & Laboratory Immunology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0467103Medicaid