Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | OP00001562 | WA |
N | 207QA0401X | Family Doctor - Addiction Medicine | OP00001562 | WA |
NPI | 1619987054 |
---|---|
Provider Name | Wayne W Kim |
First Address | Spanaway, WA 98387-8242 |
Second Address | Spanaway, WA 98387-8242 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F0104 | (02) | WA |