Avid Foot & Ankle Center, PLLC

Primary specialty

PodiatristTaxonomy code 213E00000X

Legal business name

AVID FOOT & ANKLE CENTER, PLLC

Practice address

2601 Little Elm Pkwy Ste 803
Little Elm, TX 75068-1920

Phone

(469) 430-9987

Fax

(972) 767-3608

NPI assigned

Jun 17, 2021

Last updated

Jun 17, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dae Sik Alex Kim, DPMNPI 1376959700

Title

President

Phone

(469) 430-9987

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Dae Sik Alex Kim, D.P.M.

  • Foot & Ankle Surgery Podiatrist
  • Little Elm, TX
  • NPI 1376959700
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1623888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623888000000",
    "number": "1518536200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2601 LITTLE ELM PKWY STE 803",
            "city": "LITTLE ELM",
            "state": "TX",
            "postal_code": "750681920",
            "telephone_number": "469-430-9987",
            "fax_number": "972-767-3608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 LITTLE ELM PKWY STE 803",
            "city": "LITTLE ELM",
            "state": "TX",
            "postal_code": "750681920",
            "telephone_number": "469-430-9987",
            "fax_number": "972-767-3608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVID FOOT & ANKLE CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-17",
        "last_updated": "2021-06-17",
        "certification_date": "2021-06-17",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "DAE SIK",
        "authorized_official_middle_name": "ALEX",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "469-430-9987",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Podiatrist in Little Elm, TX
• Providers in Little Elm, TX by specialty
• Podiatrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.