Provider Demographics
NPI:1548854268
Name:MOUSUMI CHANDA-KIM MD PLLC
Entity type:Organization
Organization Name:MOUSUMI CHANDA-KIM MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MOUSUMI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDA-KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-619-1793
Mailing Address - Street 1:2500 W WILLIAM CANNON DR STE 303
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-5289
Mailing Address - Country:US
Mailing Address - Phone:512-444-4001
Mailing Address - Fax:512-582-0167
Practice Address - Street 1:1905 MATTHEWS LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-6143
Practice Address - Country:US
Practice Address - Phone:512-444-4001
Practice Address - Fax:512-445-6027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-23
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty