MEDICARE: HYO J KIM MD PC

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	261Q00000X	Clinic/Center	G40291	CA

General Provider Information

NPI Number	:	1689841207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HYO J KIM MD PC

Provider Business Mailing Address
First Line	:	12 STONEGATE CT
Second Line	:
City	:	ALAMO
State	:	CA
Zip	:	94507-1745
Country	:	US
Telephone Number	:	415-928-7700
Fax Number	:

Provider Business Practice Location Address
First Line	:	2161 YGNACIO VALLEY ROAD
Second Line	:	100
City	:	WALNUT CREEK
State	:	CA
Zip	:	94598-3348
Country	:	US
Telephone Number	:	925-939-3003
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HYO J KIM
Credential	:	MD
Telephone Number	:	415-928-7700

Provider Enumeration Date	:	05/13/2008
Last Update Date	:	05/13/2008

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