Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | PO00000627 | WA |
Y | 222Z00000X | Podiatrist | PO00000627 | WA |
N | 111NR0200X | Radiology | PO00000627 | WA |
N | 213ER0200X | Radiology | PO00000627 | WA |
N | 213ES0103X | Foot & Ankle Surgery | PO00000627 | WA |
N | 213ES0131X | Foot Surgery | PO00000627 | WA |
NPI | 1477599777 |
---|---|
Provider Name | Dr. Tony D. H. Kim |
First Address | Wenatchee, WA 98801-2025 |
Second Address | Wenatchee, WA 98801-2025 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 28/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
35677 | WA STATE LABOR AND INDUSTRY (01) | WA |
480028469 | PALMETO GBA RAILROAD MEDICARE IND # (01) | WA |
8235145 | (05) | WA |
CS9149 | PALMETTO GBA RAILROAD MEDICARE GROUP # (01) | WA |
U73037 | (02) | WA |