MEDICARE: DR. BRANDON J KIM DPM

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	213EP1101X	Primary Podiatric Medicine Podiatrist	00571	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Z84078	OTHER	AZ	MEDICARE ID-PIN

Other Identifiers

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

General Provider Information

NPI Number	:	1962496323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRANDON J KIM DPM

Provider Business Mailing Address
First Line	:	1002 E MCDOWELL RD
Second Line	:	SUITE A
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2625
Country	:	US
Telephone Number	:	602-262-2663
Fax Number	:	602-258-3008

Provider Business Practice Location Address
First Line	:	1002 E MCDOWELL RD
Second Line	:	SUITE A
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2625
Country	:	US
Telephone Number	:	602-262-2663
Fax Number	:	602-258-3008

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

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	10/02/2007

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Directions to “ DR. BRANDON J KIM DPM” Practice Location

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