| Hyetae Kim, Md, Pa | |
|
1157 E 42nd St Odessa TX 79762-7723 | |
| (432) 550-5300 | |
| (432) 687-6299 |
| Full Name | Hyetae Kim, Md, Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 1157 E 42nd St, Odessa, Texas |
| Authorized Official Name and Position | Chad Haggerton (BUSINESS OFFICE MGR.) |
| Authorized Official Contact | 4325505300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Hyetae Kim, Md, Pa 1157 E 42nd St Odessa TX 79762-7723 Ph: (432) 550-5300 | Hyetae Kim, Md, Pa 1157 E 42nd St Odessa TX 79762-7723 Ph: (432) 550-5300 |
| NPI Number | 1396873170 |
|---|---|
| Provider Enumeration Date | 03/01/2007 |
| Last Update Date | 05/01/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396873170 | NPI | - | NPPES |
| 158174601 | Medicaid | TX | |
| 0017JK | Other | TX | BCBS GROUP NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | K1852 (Texas) | Primary |
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