Provider Demographics
NPI:1134112154
Name:KIM, SEUNG NAM (MD)
Entity Type:Individual
Prefix:DR
First Name:SEUNG NAM
Middle Name:
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 1:475W FALLBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-7165
Mailing Address - Country:US
Mailing Address - Phone:559-900-4951
Mailing Address - Fax:866-610-3752
Practice Address - Street 1:475W FALLBROOK AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-7165
Practice Address - Country:US
Practice Address - Phone:559-900-4951
Practice Address - Fax:866-610-3752
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-24
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32168207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A321680Medicaid
CAA26717Medicare UPIN
CA00A321680Medicaid