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NPI Code Detail

MEDICARE: KYUNG NAM KIM M.D.

MEDICARE: KYUNG NAM 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
1207RX0202XMedical Oncology Physician17248AWY
2174400000XSpecialistA910160CA
3207RH0003XHematology & Oncology PhysicianA91016CA

General Provider Information

NPI Number : 1457391773
Entity Type Code : Individual
Provider Name (Legal Business Name) : KYUNG NAM KIM M.D.
Provider Business Mailing Address
First Line : 740 OAK AVENUE PKWY STE 110
Second Line :
City : FOLSOM
State : CA
Zip : 95630-6814
Country : US
Telephone Number : 916-250-0377
Fax Number : 916-250-0378
Provider Business Practice Location Address
First Line : 1401 W 5TH ST
Second Line :
City : SHERIDAN
State : WY
Zip : 82801-2705
Country : US
Telephone Number : 307-672-1000
Fax Number : 307-674-5405
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2006
Last Update Date : 08/05/2024

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