Provider Demographics
NPI:1174042485
Name:DR. KIM'S ADULT CLINIC, PLLC
Entity type:Organization
Organization Name:DR. KIM'S ADULT CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONG
Authorized Official - Middle Name:WHAN
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-876-7301
Mailing Address - Street 1:8100 TWISTED HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:BLADENBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28320-7010
Mailing Address - Country:US
Mailing Address - Phone:910-876-7301
Mailing Address - Fax:910-648-5650
Practice Address - Street 1:8100 TWISTED HICKORY RD
Practice Address - Street 2:
Practice Address - City:BLADENBORO
Practice Address - State:NC
Practice Address - Zip Code:28320-7010
Practice Address - Country:US
Practice Address - Phone:910-876-7301
Practice Address - Fax:910-648-5650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200101455208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty