MEDICARE: DR. HYON SOO HAROLD 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	207YX0901X	Otology & Neurotology Physician	MD24993	OR

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

General Provider Information

NPI Number	:	1700924719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HYON SOO HAROLD KIM MD

Provider Business Mailing Address
First Line	:	2230 NW PETTYGROVE ST
Second Line	:	STE 120
City	:	PORTLAND
State	:	OR
Zip	:	97210-2659
Country	:	US
Telephone Number	:	503-444-7676
Fax Number	:	971-319-6647

Provider Business Practice Location Address
First Line	:	2230 NW PETTYGROVE ST
Second Line	:	STE 120
City	:	PORTLAND
State	:	OR
Zip	:	97210-2659
Country	:	US
Telephone Number	:	503-444-7676
Fax Number	:	971-319-6647

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

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	03/07/2016

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