MEDICARE: EUN HYUK KIM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	A35936	CA
2	2080N0001X	Neonatal-Perinatal Medicine Physician	A35936	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063476091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUN HYUK KIM MD

Provider Business Mailing Address
First Line	:	1832 DRY CREEK RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95124-1200
Country	:	US
Telephone Number	:	408-559-1408
Fax Number	:

Provider Business Practice Location Address
First Line	:	1832 DRY CREEK RD
Second Line	:	NEONATOLOGY DEPARTMENT
City	:	SAN JOSE
State	:	CA
Zip	:	95124-1200
Country	:	US
Telephone Number	:	408-559-1408
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	06/18/2010

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