Healthcare Provider Details

I. General information

NPI: 1124384706
Provider Name (Legal Business Name): JOHN KIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2012
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 HOSPITAL WAY
WHITEFISH MT
59937-7849
US

IV. Provider business mailing address

1222 LION MOUNTAIN DR
WHITEFISH MT
59937-8071
US

V. Phone/Fax

Practice location:
  • Phone: 406-863-3500
  • Fax: 406-308-1113
Mailing address:
  • Phone: 310-709-3232
  • Fax: 406-308-1113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35.124397
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMED-PHYS-LIC-105343
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA137561
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301106739
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number16167
License Number StateNV
# 6
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number15632C
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: