Healthcare Provider Details

I. General information

NPI: 1568451649
Provider Name (Legal Business Name): WALTER HYUN KIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16220 N SCOTTSDALE RD STE 300
SCOTTSDALE AZ
85254-1798
US

IV. Provider business mailing address

16220 N SCOTTSDALE RD STE 300
SCOTTSDALE AZ
85254-1798
US

V. Phone/Fax

Practice location:
  • Phone: 866-792-1191
  • Fax: 949-703-8203
Mailing address:
  • Phone: 866-792-1191
  • Fax: 949-703-8203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number00210
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number64496
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number64496
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: