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NPI Code Detail

MEDICARE: TAESOO KIM MD

MEDICARE: TAESOO 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
1207RN0300XNephrology Physician76485AZ

General Provider Information

NPI Number : 1740742055
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAESOO KIM MD
Provider Business Mailing Address
First Line : 1625 N CAMPBELL AVE
Second Line :
City : TUCSON
State : AZ
Zip : 85719-4330
Country : US
Telephone Number : 520-694-0111
Fax Number : 520-694-0127
Provider Business Practice Location Address
First Line : 1625 N CAMPBELL AVE
Second Line :
City : TUCSON
State : AZ
Zip : 85719-4330
Country : US
Telephone Number : 520-694-0111
Fax Number : 520-694-0127
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2019
Last Update Date : 03/10/2026

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Directions to “ TAESOO KIM MD” Practice Location

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