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NPI Code Detail

MEDICARE: JOHN KIM DO

MEDICARE: JOHN KIM DO
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
1207R00000XInternal Medicine PhysicianDO3595NV
2208M00000XHospitalist PhysicianDO3595NV

General Provider Information

NPI Number : 1104209550
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN KIM DO
Provider Business Mailing Address
First Line : PO BOX 33269
Second Line :
City : PHOENIX
State : AZ
Zip : 85067-3269
Country : US
Telephone Number : 602-406-4786
Fax Number : 916-636-4358
Provider Business Practice Location Address
First Line : 3001 SAINT ROSE PKWY
Second Line :
City : HENDERSON
State : NV
Zip : 89052-3839
Country : US
Telephone Number : 702-492-8592
Fax Number : 702-492-8045
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2015
Last Update Date : 06/24/2026

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