Active NPI
Nayeon Kim Thiesse, MD
- Otolaryngology Physician
- Lubbock, TX
National Provider Identifier
1871287391
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- BP10083595
- Practice address
- 3601 4TH St Stop 4TH
Lubbock, TX 79430-0002 - Phone
- (713) 294-8635
- NPI assigned
- Jun 7, 2023
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | BP10083595 | TX | Primary |
Addresses
Primary practice location
3601 4TH St Stop 4TH
Lubbock, TX 79430-0002
Mailing address
3601 4TH St - Stop 4TH Floor
Lubbock, TX 79430
Phone (713) 294-8635
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| BP10083595 | TX | MD | Otolaryngology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1686096000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686096000000",
"number": "1871287391",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3601 4TH ST - STOP 4TH FLOOR",
"city": "LUBBOCK",
"state": "TX",
"postal_code": "79430",
"telephone_number": "713-294-8635"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3601 4TH ST STOP 4TH",
"city": "LUBBOCK",
"state": "TX",
"postal_code": "794300002",
"telephone_number": "713-294-8635"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM THIESSE",
"first_name": "NAYEON",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-06-07",
"last_updated": "2023-06-07",
"certification_date": "2023-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "TX",
"license": "BP10083595",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lubbock, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.