Healthcare Provider Details

I. General information

NPI: 1750613089
Provider Name (Legal Business Name): HAK-JOONG KIM M.D. S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2010
Last Update Date: 02/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 W OKLAHOMA AVE SUITE 101
MILWAUKEE WI
53219-4303
US

IV. Provider business mailing address

320 SHEFFIELD DR
BROOKFIELD WI
53005-7926
US

V. Phone/Fax

Practice location:
  • Phone: 414-321-1900
  • Fax: 414-321-0089
Mailing address:
  • Phone: 414-321-1900
  • Fax: 414-321-0089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number20698-30
License Number StateWI

VIII. Authorized Official

Name: DR. HAK-JOONG KIM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 414-321-1900