Healthcare Provider Details

I. General information

NPI: 1710478250
Provider Name (Legal Business Name): HYUNJOONG WILLIAM KIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVENUE BLDG. 5, 1ST FL.
SAN FRANCISCO CA
94110
US

IV. Provider business mailing address

1001 POTRERO AVENUE BLDG. 5, 1ST FL.
SAN FRANCISCO CA
94110
US

V. Phone/Fax

Practice location:
  • Phone: 628-206-8020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number304704
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT215077
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA185835
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: