Provider Demographics
NPI:1437448081
Name:KIM, BRIAN J (AUD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
Last Name:KIM
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 W NORFOLK AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-4405
Mailing Address - Country:US
Mailing Address - Phone:402-844-8110
Mailing Address - Fax:402-844-8113
Practice Address - Street 1:3901 W NORFOLK AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4405
Practice Address - Country:US
Practice Address - Phone:402-844-8110
Practice Address - Fax:402-844-8113
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD60204165231H00000X
MO2014028198231H00000X
IL147001514231H00000X
NE431231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
F400165842Medicare PIN