MEDICARE: JOHN KIM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	G74910	CA

General Provider Information

NPI Number	:	1063484392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN KIM M.D.

Provider Business Mailing Address
First Line	:	1593 E GOLDEN VALLEY WAY
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93730-3587
Country	:	US
Telephone Number	:	559-434-4052
Fax Number	:

Provider Business Practice Location Address
First Line	:	1593 E GOLDEN VALLEY WAY STE 104
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93730-3587
Country	:	US
Telephone Number	:	559-434-4052
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	11/07/2017

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