Healthcare Provider Details

I. General information

NPI: 1114160405
Provider Name (Legal Business Name): SUSAN J KIM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2009
Last Update Date: 12/16/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6850 GEARY BLVD
SAN FRANCISCO CA
94121-1604
US

IV. Provider business mailing address

6850 GEARY BLVD
SAN FRANCISCO CA
94121-1604
US

V. Phone/Fax

Practice location:
  • Phone: 415-751-6800
  • Fax: 415-751-6808
Mailing address:
  • Phone: 415-751-6800
  • Fax: 415-751-6808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberA113591
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberA113591
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA113591
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: