MEDICARE: JAMES KIM MD

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	A63306	CA

General Provider Information

NPI Number	:	1164502639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES KIM MD

Provider Business Mailing Address
First Line	:	2350 W EL CAMINO REAL
Second Line	:	2ND FLOOR
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94040-6201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2652 EL CAMINO REAL
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95051-3041
Country	:	US
Telephone Number	:	408-524-5952
Fax Number	:

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	12/16/2011

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