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1336125798

NPI Code Detail

MEDICARE: DR. NAMOU KIM MD

MEDICARE: DR. NAMOU 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	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	MD60101869	WA
2	207Y00000X	Otolaryngology Physician	MD60101869	WA

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	298197	OTHER	WA	DEPT OF LABOR & INDUSTRIES

General Provider Information

NPI Number	:	1336125798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NAMOU KIM MD

Provider Business Mailing Address
First Line	:	PO BOX 25608
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84125-0608
Country	:	US
Telephone Number	:	206-320-4476
Fax Number	:	206-568-7043

Provider Business Practice Location Address
First Line	:	1221 MADISON ST STE 1523
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98104-1342
Country	:	US
Telephone Number	:	206-292-6464
Fax Number	:	206-292-6498

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

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	06/16/2021

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Directions to “ DR. NAMOU KIM MD” Practice Location

Language	Start Address	Practice Location

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