MEDICARE: ALEXANDER P KIM DO

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	207RG0100X	Gastroenterology Physician	20A8742	CA

General Provider Information

NPI Number	:	1265504583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER P KIM DO

Provider Business Mailing Address
First Line	:	870 SHASTA ST STE 200
Second Line	:
City	:	YUBA CITY
State	:	CA
Zip	:	95991-4117
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	870 SHASTA ST STE 200
Second Line	:
City	:	YUBA CITY
State	:	CA
Zip	:	95991-4117
Country	:	US
Telephone Number	:	530-671-3671
Fax Number	:

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

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	09/10/2012

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