Healthcare Provider Details

I. General information

NPI: 1235838350
Provider Name (Legal Business Name): JOHN KIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG 3030/3031
APO AP
96271
US

IV. Provider business mailing address

BLDG 3030/3031 INDIANHEAD AVE
APO AP
96271
US

V. Phone/Fax

Practice location:
  • Phone: 315-737-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberV3350
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: