Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A35936 | CA |
Y | 2080N0001X | Neonatal-Perinatal Doctor | A35936 | CA |
NPI | 1063476091 |
---|---|
Provider Name | Eun Hyuk Kim |
First Address | San Jose, CA 95124-1200 |
Second Address | San Jose, CA 95124-1200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 18/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A359360 | (05) | CA |
A27947 | (02) | CA |