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NPI Code Detail

MEDICARE: SAMUEL KIM

MEDICARE:   SAMUEL  KIM
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
1207T00000XNeurological Surgery Physician246540NY
2207T00000XNeurological Surgery Physician60680AZ

General Provider Information

NPI Number : 1215917091
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMUEL KIM
Provider Business Mailing Address
First Line : 2415 E CAMELBACK RD STE 700
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-4245
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2415 E CAMELBACK RD STE 700
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-4245
Country : US
Telephone Number : 424-443-4749
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2006
Last Update Date : 07/05/2024

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Directions to “ SAMUEL KIM ” Practice Location

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