MARY T KIM (NPI# 1033192828) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033192828 |
| Entity Type | Individual |
| Full Name | MARY T KIM |
| Credential | M.D. |
| Practice Address |
1501 Kings Hwy Shreveport LA 71103-4228 |
| Practice Telephone | 3186756154 |
| Mailing Telephone | 3186756154 |
| Enumeration Date | 2005-11-25 |
| Last Update Date | 2009-05-18 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0122X |
Surgery Specialization: Plastic and Reconstructive Surgery |
MD200563 | LA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 1581518 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053729467 | Mary Grace Kim | Dentist | 8321 W Golf Rd, Niles, IL 60714-1113 | 2014-07-29 |
| 1568581536 | Mary M. Kim | Optometrist | 978 Main St., S. Weymouth, MA 02190 | 2007-03-28 |
| 1902880123 | Mary M. Kim | Internal Medicine | 1624 Mars Hill Rd, Suite B, Watkinsville, GA 30677-4813 | 2005-12-01 |
| 1497301261 | Mary Suhyun Kim | Student in an Organized Health Care Education/Training Program | 3800 Reservoir Rd Nw, Washington, DC 20007-2113 | 2019-08-16 |
| 1861975344 | Mary Kim | Registered Nurse | 6223 N Canton Center Rd Ste 201, Canton, MI 48187-2696 | 2018-09-11 |
| 1184165516 | Mary Kim | Dentist | 251 E Huron St, Chicago, IL 60611-2908 | 2017-03-18 |
| 1730523309 | Mary E Kim | Dermatology | 9000 W Wisconsin Ave, Milwaukee, WI 53226-4874 | 2013-04-25 |
| 1275720930 | Mary Kim | Physician Assistant | 4502 Medical Dr, San Antonio, TX 78229-4402 | 2007-09-26 |
| 1790804060 | Mary Wai Ming Kim | Dentist | 1441 Kapiolani Blvd, Suite 1515, Honolulu, HI 96814 | 2007-03-28 |
| 1508998782 | Mary Ann Kim | Dentist | 233 S Wacker Dr, Lower Level 1, Chicago, IL 60606-6306 | 2007-03-12 |
| Street Address |
1501 KINGS HWY |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71103-4228 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801890769 | F Dean Griffen | Surgery | 1501 Kings Hwy, Shreveport, LA 71103-4228 | 2005-06-09 |
| 1336747625 | Lana Nasief | Student in an Organized Health Care Education/Training Program | 1501 Kings Hwy, Shreveport, LA 71103-4228 | 2020-10-09 |
| 1558968834 | Dinesh Regalla | Student in an Organized Health Care Education/Training Program | 1501 Kings Hwy, Shreveport, LA 71103-4228 | 2020-10-08 |
| 1588261283 | Divleen Sidhu | Student in an Organized Health Care Education/Training Program | 1501 Kings Hwy, Shreveport, LA 71103-4228 | 2020-10-06 |
| 1023624517 | Grace Hoffman | Pharmacist | 1501 Kings Hwy, Shreveport, LA 71103-4228 | 2020-09-20 |
| 1194330761 | Yousef Hasan | Student in an Organized Health Care Education/Training Program | 1501 Kings Hwy, Shreveport, LA 71103-4228 | 2020-09-10 |
| 1790399277 | Ricardo Murguia Fuentes | Student in an Organized Health Care Education/Training Program | 1501 Kings Hwy, Shreveport, LA 71103-4228 | 2020-09-02 |
| 1013521509 | Tahir Ahmad | Student in an Organized Health Care Education/Training Program | 1501 Kings Hwy, Shreveport, LA 71103-4228 | 2020-09-02 |
| 1376155309 | Ayesha Malik | Student in an Organized Health Care Education/Training Program | 1501 Kings Hwy, Shreveport, LA 71103-4228 | 2020-08-20 |
| 1104438324 | Elleny Gutierrez | Student in an Organized Health Care Education/Training Program | 1501 Kings Hwy, Shreveport, LA 71103 | 2020-08-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083124887 | Elizabeth Ponder | Case Manager/Care Coordinator | 404 Hearne Avenue, Shreveport, LA 71103 | 2017-10-05 |
| 1245648393 | Madiha Tariq | General Acute Care Hospital | Rheumatology Clinic, 1501 Kings Hwy, Sheveport, LA 71103 | 2014-07-31 |
| 1659782688 | Jennifer G Smith | Pharmacist | 1725 Claiborne Ave, Shreveport, LA 71103 | 2014-05-13 |
| 1336568823 | Taylor Jieun Jung | Student in an Organized Health Care Education/Training Program | Lsu Health Sciences Center 1501 Kings Highway, Department of Oral & Maxillofacial Surgery Room 530, Shreveport, LA 71103 | 2014-04-10 |
| 1578984746 | Jamie Terrell | Pharmacist | 1625 Claiborne Ave, Shreveport, LA 71103 | 2013-12-13 |
| 1346675188 | Srijan Tandukar | Internal Medicine | 2751 Albert L Bicknell Dr Ste 2b, Shreveport, LA 71103 | 2013-09-12 |
| 1699017681 | Deanna Elise Mossallati | Internal Medicine | 8551 Greenwood Rd, Suite 410, Shreveport, LA 71103 | 2013-03-18 |
| 1346527330 | Tim M Smith | Clinical Exercise Physiologist | 3200 Greenwood Rd., Shreveport, LA 71103 | 2011-11-04 |
| 1144451683 | Second Chance Recovery | Durable Medical Equipment & Medical Supplies | 3816 Linwood, Shreveport, LA 71103 | 2009-07-31 |
| 1093919920 | Neeraj Singh | Internal Medicine | 2751 Albert L Bicknell Dr Fl 4, Shreveport, LA 71103 | 2007-06-13 |
| Find all providers in zip 71103 | ||||
| Taxonomy Code | 2086S0122X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Plastic and Reconstructive Surgery |
| A surgeon who specializes in plastic and reconstructive surgery. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate is issued by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700929874 | The Plastic Surgery Center LLP | Surgery | 385 Bert Kouns Ind. Loop, Bldg 100, Shreveport, LA 71106-8124 | 2007-02-15 |
| 1912936196 | Kenneth W. Sanders, Md and Willis-knighton Medical Center | Surgery | 1811 East Bert Kouns, Suite 160, Shreveport, LA 71105-5505 | 2006-07-01 |
| 1699758474 | Forrest P Wall | Surgery | 385 Bert Kound Ind. Loop, Bldg 100, Shreveport, LA 71106-8124 | 2005-11-25 |
| 1679555072 | Stephen Jon Ramey | Surgery | 1505 E Bert Kouns Industrial Loop # 101, Shreveport, LA 71105-5723 | 2005-11-19 |
| 1245229624 | Holly Casey Wall | Surgery | 8600 Fern Ave, Shreveport, LA 71105-5639 | 2005-10-18 |
| 1861496556 | Daniel R Knight | Surgery | 2533 Bert Kouns Industrial Loop Ste 106, Shreveport, LA 71118-3158 | 2005-06-09 |
| 1174808794 | Holly D. Casey, Md. A Professional Medical Corp. | Surgery | 8600 Fern Avenue, Shreveport, LA 71105 | 2011-10-14 |
| 1851563464 | Neurotrix, Inc. | Surgery | 1657 E 70th St, Shreveport, LA 71105-5115 | 2008-03-24 |
| 1275522682 | Simeon Wall Jr. | Surgery | 8600 Fern Ave, Shreveport, LA 71105-5639 | 2005-10-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003430257 | Thibodaux Regional Network Development Corporation | Surgery | 604 N Acadia Rd Ste 410, Thibodaux, LA 70301-4897 | 2020-06-03 |
| 1942590153 | Jenna Martin Bourgeois | Surgery | Associates In Plastic Surgery, 8425 Cumberland Place, Baton Rouge, LA 70806 | 2011-04-10 |
| 1710121306 | John P Guste | Surgery | 3900 Veterans Blvd., Suite 200, Metairie, LA 70002 | 2009-04-27 |
| 1295808863 | James W Wade | Surgery | 5233 Dijon Drive, Baton Rouge, LA 70817 | 2006-11-15 |
| 1861595969 | Terry A Cromwell | Surgery | 1101 South College Road, Suite 400, Lafayette, LA 70503 | 2006-09-06 |
| 1154344000 | Scott Keith Sullivan Jr. | Surgery | 1717 Saint Charles Ave, New Orleans, LA 70130-5223 | 2006-07-25 |
| 1568482339 | Herbert Stephen Maguire | Surgery | 501 Medical Center Dr Ste 1b, Alexandria, LA 71301-8124 | 2006-07-21 |
| 1346260205 | O'neil Joseph Engeron | Surgery | 615 Dunn St, Houma, LA 70360-4707 | 2006-07-20 |
| 1134190465 | Ralph W Colpitts | Surgery | 2000 Southwood Dr, Suite B, Lake Charles, LA 70605-4138 | 2006-01-26 |
| 1265054969 | Ford Plastic & Reconstructive Surgery Pmc | Surgery | 4864 Bluebonnet Blvd, Baton Rouge, LA 70809-9666 | 2020-05-15 |
| Find all providers with the same taxonomy | ||||
| City | SHREVEPORT |
| Zip Code | 71103 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.