1215235676 NPI number — DAVID K. KIM, MD, INC

Table of content: (NPI 1215235676)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215235676 NPI number — DAVID K. KIM, MD, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID K. KIM, MD, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215235676
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
490 POST ST
Provider Second Line Business Mailing Address:
933
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94102-1401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-773-0800
Provider Business Mailing Address Fax Number:
415-986-0816

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
490 POST ST
Provider Second Line Business Practice Location Address:
933
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94102-1401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-773-0800
Provider Business Practice Location Address Fax Number:
415-986-0816
Provider Enumeration Date:
03/09/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
QUETEL
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
415-902-8578

Provider Taxonomy Codes

  • Taxonomy code: 207YX0905X , with the licence number:  A65349 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)