Basic Information
Provider Information
NPI: 1003000597
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KIM
FirstName: DAE
MiddleName: Y
NamePrefix: DR.
NameSuffix:  
Credential: M.D., PH.D
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1145 S UTICA AVE
Address2: SUITE 202
City: TULSA
State: OK
PostalCode: 741044000
CountryCode: US
TelephoneNumber: 9185793130
FaxNumber: 9185793139
Practice Location
Address1: 1145 S UTICA AVE
Address2: SUITE 202
City: TULSA
State: OK
PostalCode: 741044000
CountryCode: US
TelephoneNumber: 9185793130
FaxNumber: 9185793139
Other Information
ProviderEnumerationDate: 08/28/2007
LastUpdateDate: 07/15/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208800000X31577OKY Allopathic & Osteopathic PhysiciansUrology 

ID Information
IDTypeStateIssuerDescription
8EB319 (MDACC)01TXBCBSOTHER
324649801 (MDACC)05TX MEDICAID


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