Kisung Kim
Adolescent Medicine
2450 Sister Mary Columba Dr
Red Bluff
, California 96080-4356
Kisung Kim
Adolescent Medicine
2450 Sister Mary Columba Dr
Red Bluff
, California 96080-4356
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About
Features
Specialties
- Adolescent Medicine
Languages spoken
- English
Location
First Address
- Kisung Kim
- 2450 Sister Mary Columba Dr
- Red Bluff, CA
- Zip : 96080-4356
- Phone :
Second Address
- Kisung Kim
- 2450 Sister Mary Columba Dr
- Red Bluff, CA
- Zip : 96080-4356
- Fax : (530) 527-3720
- Phone : (530) 527-0414
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 2080A0000X | Adolescent Medicine | A141207 | CA |
National Provider Identifier
| NPI | 1073939815 |
|---|---|
| Provider Name | Kisung Kim |
| First Address | Red Bluff, CA 96080-4356 |
| Second Address | Red Bluff, CA 96080-4356 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 17/03/2014 |
| Last Update Date | 03/04/2019 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.