Healthcare Provider Details

I. General information

NPI: 1023698248
Provider Name (Legal Business Name): TAE UN KIM DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMMY KIM DO

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 18TH ST
SAN FRANCISCO CA
94143-4200
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-7000
  • Fax:
Mailing address:
  • Phone: 410-933-6423
  • Fax: 410-500-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25438
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: