Provider Demographics
NPI:1902802796
Name:MASTERS, KIM JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:JAMES
Last Name:MASTERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3328
Mailing Address - Street 2:
Mailing Address - City:TEGA CAY
Mailing Address - State:SC
Mailing Address - Zip Code:29708-3328
Mailing Address - Country:US
Mailing Address - Phone:803-396-2130
Mailing Address - Fax:803-396-2130
Practice Address - Street 1:200 ERMINE RD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29170-2024
Practice Address - Country:US
Practice Address - Phone:803-791-9918
Practice Address - Fax:803-926-5925
Is Sole Proprietor?:No
Enumeration Date:2005-06-26
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC152052084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCC89312Medicare UPIN