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General NPI Number Information
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NPI Number | 1457391773
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Entity Type | Individual
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Provider Name | KYUNG NAM KIM M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 08/05/2024
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Provider Practice Location Address
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Address Line | 1401 W 5TH ST
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City | SHERIDAN
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State | WY
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Zip | 82801-2705
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Country | US
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Telephone | 307-672-1000
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Fax | 307-674-5405
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Provider Business Mailing Address
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Address Line | 740 OAK AVENUE PKWY STE 110
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City | FOLSOM
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State | CA
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Zip | 95630-6814
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Country | US
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Telephone | 916-250-0377
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Fax | 916-250-0378
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | 17248A
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A910160
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | A91016
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License Number State | CA
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