MEDICARE: DAVID HYUNSOO 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	207R00000X	Internal Medicine Physician	9568	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CC6606	OTHER	NV	BLU CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1396705661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID HYUNSOO KIM MD

Provider Business Mailing Address
First Line	:	5380 S RAINBOW BLVD
Second Line	:	310
City	:	LAS VEGAS
State	:	NV
Zip	:	89118
Country	:	US
Telephone Number	:	702-939-1600
Fax Number	:	702-932-0440

Provider Business Practice Location Address
First Line	:	5380 S RAINBOW BLVD
Second Line	:	310
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-1877
Country	:	US
Telephone Number	:	702-939-1600
Fax Number	:

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	07/08/2007

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Directions to “ DAVID HYUNSOO KIM MD” Practice Location

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