Provider Demographics
NPI:1518048776
Name:KIM, KYE S (MD)
Entity type:Individual
Prefix:DR
First Name:KYE
Middle Name:S
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:11995 SINGLETREE LN
Mailing Address - Street 2:SUITE 500
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5347
Mailing Address - Country:US
Mailing Address - Phone:952-595-1300
Mailing Address - Fax:612-294-4903
Practice Address - Street 1:17 SCOTT RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-8117
Practice Address - Country:US
Practice Address - Phone:952-595-1301
Practice Address - Fax:952-595-1301
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2060382085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ25002OtherBLUE CROSS BLUE SHIELD MA
MAKI A34050Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
MA0181102Medicaid
MAH62298Medicare UPIN