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General NPI Number Information
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NPI Number | 1952325359
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Entity Type | Individual
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Provider Name | THEODORE Y KIM D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 3851 PIPER ST STE U340
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City | ANCHORAGE
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State | AK
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Zip | 99508-6904
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Country | US
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Telephone | 907-562-0321
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Fax | 907-562-0321
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Provider Business Mailing Address
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Address Line | PO BOX 74900
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City | CHICAGO
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State | IL
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Zip | 60675-4900
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Country | US
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Telephone | 907-562-0321
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Fax | 907-562-2683
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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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 129714
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License Number State | AK
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