Active NPI
Peter Tae Wan Kim, MD
- Transplant Surgery Physician
- Dallas, TX
National Provider Identifier
1437315264
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Transplant Surgery Physician
- License
- N1367
- Practice address
- 3410 Worth St Ste 950
Dallas, TX 75246-2064 - Phone
- (214) 820-2050
- NPI assigned
- Jul 31, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Transplant Surgery Physician | 204F00000X | N1367 | TX | Primary |
Addresses
Primary practice location
3410 Worth St Ste 950
Dallas, TX 75246-2064
Mailing address
3410 Worth St Ste 950
Dallas, TX 75246-2064
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 304424001 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| N1367 | TX | MD | Pediatric Emergency Medicine (Pediatrics) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1217462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1353369600000",
"number": "1437315264",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3410 WORTH ST STE 950",
"city": "DALLAS",
"state": "TX",
"postal_code": "752462064"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3410 WORTH ST STE 950",
"city": "DALLAS",
"state": "TX",
"postal_code": "752462064",
"telephone_number": "214-820-2050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "PETER",
"middle_name": "TAE WAN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-07-31",
"last_updated": "2012-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "204F00000X",
"taxonomy_group": "",
"desc": "Transplant Surgery",
"state": "TX",
"license": "N1367",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "304424001",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.