Healthcare Provider Details

I. General information

NPI: 1386677144
Provider Name (Legal Business Name): MICHAEL SANG-HAK KIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 15TH ST STE 310
GREELEY CO
80631-4562
US

IV. Provider business mailing address

1800 15TH ST STE 310
GREELEY CO
80631-4562
US

V. Phone/Fax

Practice location:
  • Phone: 970-810-0900
  • Fax:
Mailing address:
  • Phone: 970-810-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD60080825
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberDR.0044091
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberDR.0044091
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD60080825
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: