Provider Demographics
NPI:1255305173
Name:KIM, DAVID KEESU (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:KEESU
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 1:2512 WHEATON WAY
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3399
Mailing Address - Country:US
Mailing Address - Phone:360-782-3600
Mailing Address - Fax:
Practice Address - Street 1:2200 NW MYHRE RD
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7681
Practice Address - Country:US
Practice Address - Phone:360-830-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN447472085R0202X
WAMD000489422085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA269239OtherWA LABOR & INDUSTRIES
MN203670300Medicaid
WAG8894761Medicare PIN
H63203Medicare UPIN
MN203670300Medicaid
WA8868975Medicare PIN
WAG8896888Medicare PIN
WAG8896890Medicare PIN
WAG8896891Medicare PIN
WAG8896893Medicare PIN
WAG8881481Medicare PIN
MN110237883Medicare ID - Type UnspecifiedRAIL ROAD
WAG8896892Medicare PIN