Healthcare Provider Details

I. General information

NPI: 1255489852
Provider Name (Legal Business Name): KIMI HMAR ZOOK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 UPLAND ST
KENAI AK
99611-8026
US

IV. Provider business mailing address

508 UPLAND ST
KENAI AK
99611-8026
US

V. Phone/Fax

Practice location:
  • Phone: 907-335-7200
  • Fax:
Mailing address:
  • Phone: 907-335-7500
  • Fax: 423-798-1755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number222586
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34851
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: