Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 30908 | WI |
NPI | 1093708356 |
---|---|
Provider Name | Dr. Eun Young Kim |
First Address | Oshkosh, WI 54902-5825 |
Second Address | Oshkosh, WI 54902-5825 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2005 |
Last Update Date | 28/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E38703 | (02) | WI |