Healthcare Provider Details

I. General information

NPI: 1952377079
Provider Name (Legal Business Name): CANDACE KIM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE BLDG 25
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

505 PARNASSUS AVE RM 1556 L
SAN FRANCISCO CA
94143
US

V. Phone/Fax

Practice location:
  • Phone: 628-206-8000
  • Fax: 628-206-8965
Mailing address:
  • Phone: 415-502-3627
  • Fax: 415-514-9702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberC54498
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC54498
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: