Hyetae Kim, MD, PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

K1852 Issued in TX

Legal business name

HYETAE KIM, MD, PA

Practice address

1157 E 42ND St
Odessa, TX 79762-7723

Phone

(432) 550-5300

Fax

(432) 687-6299

NPI assigned

Mar 1, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Chad Haggerton

Title

Business Office MGR.

Phone

(432) 550-5300

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Hae Ran Rhim-Kim, MD

  • Rheumatology Physician
  • Las Vegas, NV
  • NPI 1922024165
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209600000000",
    "number": "1396873170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1157 E 42ND ST",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797627723",
            "telephone_number": "432-550-5300",
            "fax_number": "432-687-6299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1157 E 42ND ST",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797627723",
            "telephone_number": "432-550-5300",
            "fax_number": "432-687-6299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HYETAE KIM, MD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2008-05-01",
        "status": "A",
        "authorized_official_last_name": "HAGGERTON",
        "authorized_official_first_name": "CHAD",
        "authorized_official_title_or_position": "BUSINESS OFFICE MGR.",
        "authorized_official_telephone_number": "432-550-5300"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "K1852",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "158174601",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP NUMBER",
            "identifier": "0017JK",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tonya Hurst, OTR
• Baylie Marie Hurt, D.C.
• Janice Lee Hurt, LPC-S
• Karrar Husain, MD
• Kathryn Nichole Hutton, DO
• Elizabeth Funmilayo Igharoro
• Stephanie Ochuko Igharoro
• Andrea Ihegword
• Timothy Oseaga Ihongbe, MD, MPH, PHD
• Ashley Ikwuezunma

• Family Medicine Physician in Odessa, TX
• Providers in Odessa, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.