Healthcare Provider Details

I. General information

NPI: 1992970206
Provider Name (Legal Business Name): HYUNG J. KIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOHN KIM M.D.

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 NE 139TH ST
VANCOUVER WA
98686-2742
US

IV. Provider business mailing address

729 EL CAMINO REAL 201
BURLINGAME CA
94010-5045
US

V. Phone/Fax

Practice location:
  • Phone: 503-413-8407
  • Fax:
Mailing address:
  • Phone: 919-824-2548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD61398080
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA97288
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA97288
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: