MEDICARE: HENRY YUNWOONG 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	208100000X	Physical Medicine & Rehabilitation Physician	G77410	CA
2	208VP0014X	Interventional Pain Medicine Physician	MD 60057584	WA

General Provider Information

NPI Number	:	1083740708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HENRY YUNWOONG KIM MD

Provider Business Mailing Address
First Line	:	1460 N 16TH AVE
Second Line	:	SUITE D
City	:	YAKIMA
State	:	WA
Zip	:	98902-7102
Country	:	US
Telephone Number	:	509-574-3805
Fax Number	:

Provider Business Practice Location Address
First Line	:	1460 N 16TH AVE
Second Line	:	SUITE D
City	:	YAKIMA
State	:	WA
Zip	:	98902-7102
Country	:	US
Telephone Number	:	509-574-3805
Fax Number	:

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	08/31/2011

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