MEDICARE: MICHELLE A 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	207Q00000X	Family Medicine Physician	A81149	CA

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	:	1801982343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE A KIM MD

Provider Business Mailing Address
First Line	:	880 ALDER AVE FL 2
Second Line	:
City	:	INCLINE VILLAGE
State	:	NV
Zip	:	89451-8335
Country	:	US
Telephone Number	:	775-831-6600
Fax Number	:

Provider Business Practice Location Address
First Line	:	880 ALDER AVE
Second Line	:
City	:	INCLINE VILLAGE
State	:	NV
Zip	:	89451-8335
Country	:	US
Telephone Number	:	775-831-6200
Fax Number	:

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	03/23/2023

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