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NPI Code Detail

MEDICARE: DR. HEEBOK KIM MD

MEDICARE: DR. HEEBOK 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
1174400000XSpecialistC42386CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1730260910
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. HEEBOK KIM MD
Provider Business Mailing Address
First Line : 1998 N ARROWHEAD AVE
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92405-4116
Country : US
Telephone Number : 909-882-0988
Fax Number : 909-886-1301
Provider Business Practice Location Address
First Line : 1998 N ARROWHEAD AVE
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92405-4116
Country : US
Telephone Number : 909-882-0988
Fax Number : 909-886-1301
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2006
Last Update Date : 03/07/2023

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