Provider Demographics
NPI:1063476091
Name:KIM, EUN HYUK (MD)
Entity Type:Individual
Prefix:
First Name:EUN
Middle Name:HYUK
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1832 DRY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-1200
Mailing Address - Country:US
Mailing Address - Phone:408-559-1408
Mailing Address - Fax:
Practice Address - Street 1:1832 DRY CREEK RD
Practice Address - Street 2:NEONATOLOGY DEPARTMENT
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-1200
Practice Address - Country:US
Practice Address - Phone:408-559-1408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35936208000000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A359360Medicaid
CA00A359360Medicare PIN
CA00A359360Medicaid