Healthcare Provider Details

I. General information

NPI: 1073256160
Provider Name (Legal Business Name): JINSUNG KIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2022
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 WILLOW RD
MENLO PARK CA
94025-2539
US

IV. Provider business mailing address

795 WILLOW RD
MENLO PARK CA
94025-2539
US

V. Phone/Fax

Practice location:
  • Phone: 650-614-9997
  • Fax:
Mailing address:
  • Phone: 650-614-9997
  • Fax: 650-614-8416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA201287
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: