| Doctor Name: | DR. KIM EDWARD THIELE |
| NPI Number: | 1043361629 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.O. |
| License Number: | 4125 |
| Business Practice Address: | 105 Trading Bay Dr Suite 105 Kenai, AK - 996117717 |
| Business Phone Number: | 9072835000 |
| Business Fax Number: | |
| Mailing Address: | 105 Trading Bay Dr, Suite 105 KENAI |
| State: | AK |
| Postal Code: | 996117717 |
| Phone Number: | 9072835000 |
| Fax Number: | |
| NPI Enumeration Date: | 01/12/2007 |
| NPI Last Update Date: | 04/29/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261Q00000X |
| License Number: | 4125 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AK |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |