| Doctor Name: | CHARLES KIM |
| NPI Number: | 1003077769 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.O. |
| License Number: | BP10032227 |
| Business Practice Address: | 3601 4th St Lubbock, TX - 794300002 |
| Business Phone Number: | 8067433004 |
| Business Fax Number: | |
| Mailing Address: | 906 Milwaukee Ave Apt 609, LUBBOCK |
| State: | TX |
| Postal Code: | 794165965 |
| Phone Number: | 3059844186 |
| Fax Number: | |
| NPI Enumeration Date: | 06/24/2008 |
| NPI Last Update Date: | 08/23/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | BP10032227 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |