MEDICARE: EUGENE M KIM

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	208C00000X	Colon & Rectal Surgery Physician	33968	AZ

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	:	1770570293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUGENE M KIM

Provider Business Mailing Address
First Line	:	1441 N 12TH ST FL 3
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2837
Country	:	US
Telephone Number	:	602-521-5100
Fax Number	:	623-707-4243

Provider Business Practice Location Address
First Line	:	1441 N 12TH ST FL 3
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2837
Country	:	US
Telephone Number	:	602-521-5100
Fax Number	:	623-707-4243

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

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	07/16/2025

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Directions to “ EUGENE M KIM ” Practice Location

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