Healthcare Provider Details

I. General information

NPI: 1851485056
Provider Name (Legal Business Name): KEVIN B. KIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 02/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 WEBSTER ST STE 326
SAN FRANCISCO CA
94115-2378
US

IV. Provider business mailing address

2100 WEBSTER ST #326
SAN FRANCISCO CA
94115-2373
US

V. Phone/Fax

Practice location:
  • Phone: 415-885-8600
  • Fax: 415-885-8680
Mailing address:
  • Phone: 832-721-3779
  • Fax: 415-885-8680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberL4495
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: