Provider Demographics
NPI:1548399413
Name:MENDEZ, KIRU KOREA (MD)
Entity type:Individual
Prefix:
First Name:KIRU
Middle Name:KOREA
Last Name:MENDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 W D ST
Mailing Address - Street 2:
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-3506
Mailing Address - Country:US
Mailing Address - Phone:803-909-5937
Mailing Address - Fax:
Practice Address - Street 1:222 SOUTH HERLONG AVE.
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732
Practice Address - Country:US
Practice Address - Phone:803-909-5937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-00432207R00000X
SC35877207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5907178Medicaid
SCN0043AMedicaid
NC2070009Medicare PIN
NC5907178Medicaid