Provider Demographics
NPI:1295822468
Name:KIM, CLIFFORD INTAIK (MD)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:INTAIK
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:39199 LIBERTY ST
Mailing Address - Street 2:BUILDING B
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1501
Mailing Address - Country:US
Mailing Address - Phone:510-791-4000
Mailing Address - Fax:510-791-4036
Practice Address - Street 1:39199 LIBERTY ST
Practice Address - Street 2:BUILDING B
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1501
Practice Address - Country:US
Practice Address - Phone:510-791-4000
Practice Address - Fax:510-791-4036
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG70160207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG13013Medicare UPIN