Provider Demographics
NPI:1730150483
Name:VO, KIM VAN (MD)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:VAN
Last Name:VO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:204 COWDRAY PARK
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-8128
Mailing Address - Country:US
Mailing Address - Phone:803-736-0963
Mailing Address - Fax:803-736-0963
Practice Address - Street 1:3511 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6504
Practice Address - Country:US
Practice Address - Phone:803-771-0518
Practice Address - Fax:803-771-7286
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2010-02-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC10735207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCC61422Medicare UPIN