Healthcare Provider Details

I. General information

NPI: 1174218614
Provider Name (Legal Business Name): MINDY MINJEONG KIM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 18TH ST
SAN FRANCISCO CA
94143-4200
US

IV. Provider business mailing address

675 18TH ST
SAN FRANCISCO CA
94143-4200
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-7000
  • Fax: 415-502-6361
Mailing address:
  • Phone: 416-476-7000
  • Fax: 415-502-6361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA197696
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: