MEDICARE: DR. DONG KUN KIM M.D.

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	207R00000X	Internal Medicine Physician	251637	MA
2	2085R0202X	Diagnostic Radiology Physician	61548	MN

General Provider Information

NPI Number	:	1265789457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONG KUN KIM M.D.

Provider Business Mailing Address
First Line	:	200 1ST ST SW
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55905-0001
Country	:	US
Telephone Number	:	507-284-2511
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 1ST ST SW
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55905-5502
Country	:	US
Telephone Number	:	507-284-2511
Fax Number	:

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

Provider Enumeration Date	:	08/07/2012
Last Update Date	:	08/14/2020

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Directions to “ DR. DONG KUN KIM M.D.” Practice Location

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