Provider Demographics
NPI:1871578252
Name:KIM, STANLEY H (MD)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:H
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8333 CROSS PARK DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-5154
Mailing Address - Country:US
Mailing Address - Phone:512-494-6024
Mailing Address - Fax:866-563-6244
Practice Address - Street 1:8333 CROSS PARK DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754-5154
Practice Address - Country:US
Practice Address - Phone:512-494-6024
Practice Address - Fax:866-563-6244
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL64722085R0204X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162671501Medicaid
8A8256Medicare PIN