Healthcare Provider Details

I. General information

NPI: 1649807967
Provider Name (Legal Business Name): NATHANIEL JINYOUNG KIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 N CAMPBELL AVE STE 5153
TUCSON AZ
85724-3715
US

IV. Provider business mailing address

743 SPRING ST NE STE 710
GAINESVILLE GA
30501-3715
US

V. Phone/Fax

Practice location:
  • Phone: 520-626-1232
  • Fax:
Mailing address:
  • Phone: 770-219-8730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01100164A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number69599
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: