Provider Demographics
NPI:1073578704
Name:KIM, CASEY KWON (MD)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:KWON
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:18623 HIGHWAY 99
Mailing Address - Street 2:STE 230
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-4552
Mailing Address - Country:US
Mailing Address - Phone:425-672-8282
Mailing Address - Fax:425-275-5144
Practice Address - Street 1:18623 HIGHWAY 99
Practice Address - Street 2:STE 230
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-4552
Practice Address - Country:US
Practice Address - Phone:425-672-8282
Practice Address - Fax:425-275-5144
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2011-02-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00046002207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1122969Medicaid