Healthcare Provider Details

I. General information

NPI: 1023304797
Provider Name (Legal Business Name): SEAN W KIM D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19829 N 27TH AVE HOSPITALIST OFFICE
PHOENIX AZ
85027-4001
US

IV. Provider business mailing address

19829 N 27TH AVE ATTN: HOSPITALIST OFFICE
PHOENIX AZ
85027-4001
US

V. Phone/Fax

Practice location:
  • Phone: 623-683-0142
  • Fax:
Mailing address:
  • Phone: 623-683-0142
  • Fax: 623-879-1563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number009888
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: