MEDICARE: DR. BRIAN KAP-SOO KIM M.D.

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	207R00000X	Internal Medicine Physician	MD00044497	WA
2	207RH0000X	Hematology (Internal Medicine) Physician	MD00044497	WA
3	207RX0202X	Medical Oncology Physician	MD00044497	WA
4	207R00000X	Internal Medicine Physician	G88900	CA
5	207RH0003X	Hematology & Oncology Physician	G88900	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00185603	OTHER		RAILROAD MEDICARE

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
2	5339KI	OTHER		REGENCE BLUE SHIELD
3	5596153	OTHER		AETNA
5	193335	OTHER	WA	LABOR & INDUSTRIES
6	3733057	OTHER		AETNA

General Provider Information

NPI Number	:	1871532051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN KAP-SOO KIM M.D.

Provider Business Mailing Address
First Line	:	10470 OLD PLACERVILLE RD
Second Line	:	SUITE 100
City	:	SACRAMENTO
State	:	CA
Zip	:	95827-2539
Country	:	US
Telephone Number	:	800-470-0071
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 L STREET
Second Line	:	SUITE 300
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-7098
Country	:	US
Telephone Number	:	916-453-3300
Fax Number	:	916-453-3313

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	03/07/2023

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Directions to “ DR. BRIAN KAP-SOO KIM M.D.” Practice Location

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