MEDICARE: KIHYUN KIM D.O.

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	207P00000X	Emergency Medicine Physician	20A9251	CA
2	207P00000X	Emergency Medicine Physician	36112639	IL

General Provider Information

NPI Number	:	1689637506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIHYUN KIM D.O.

Provider Business Mailing Address
First Line	:	55 EIDER RUN
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92618-1328
Country	:	US
Telephone Number	:	760-383-5575
Fax Number	:

Provider Business Practice Location Address
First Line	:	390 NORTH LOOP ROAD
Second Line	:	BLDG 390
City	:	FORT IRWIN
State	:	CA
Zip	:	92310-5109
Country	:	US
Telephone Number	:	760-383-5575
Fax Number	:

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

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	12/23/2025

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