Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | 42031 | AZ |
Y | 207YS0123X | Facial Plastic Surgeon | MD27979 | OR |
NPI | 1689720468 |
---|---|
Provider Name | Dr. Michael M Kim |
First Address | Portland, OR 97210-2865 |
Second Address | Portland, OR 97210-2865 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2007 |
Last Update Date | 02/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
218503 | (05) | OR |
433505 | (05) | AZ |
807968400 | (05) | ID |