Healthcare Provider Details

I. General information

NPI: 1043313992
Provider Name (Legal Business Name): STEVEN SUKHO KIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5504 MONTEREY RD
SAN JOSE CA
95138-1529
US

IV. Provider business mailing address

40910 FREMONT BLVD
FREMONT CA
94538-4375
US

V. Phone/Fax

Practice location:
  • Phone: 408-729-9700
  • Fax: 408-574-0175
Mailing address:
  • Phone: 510-770-8040
  • Fax: 510-770-8141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG69347
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License NumberG69347
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: