Healthcare Provider Details

I. General information

NPI: 1902241573
Provider Name (Legal Business Name): BRIAN A KIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 03/07/2023
Certification Date: 03/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7115 GREENBACK LN FL 1
CITRUS HEIGHTS CA
95621-6133
US

IV. Provider business mailing address

3400 DATA DR
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 916-536-2442
  • Fax: 916-536-2598
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA134093
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: