Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 60765-20 | WI |
NPI | 1407144686 |
---|---|
Provider Name | Dr. Joohyun Kim |
First Address | Milwaukee, WI 53226-3522 |
Second Address | Milwaukee, WI 53226-3522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2011 |
Last Update Date | 12/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1407144686 | (05) | WI |