Provider Demographics
NPI:1386677144
Name:KIM, MICHAEL SANG-HAK (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SANG-HAK
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 1:1800 15TH ST STE 310
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-4562
Mailing Address - Country:US
Mailing Address - Phone:970-810-0900
Mailing Address - Fax:
Practice Address - Street 1:1800 15TH ST STE 310
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-4562
Practice Address - Country:US
Practice Address - Phone:970-810-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60080825207RC0000X, 207RI0011X
CO44091207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0250742OtherLABOR & INDUSTRIES
WA1386677144Medicaid
CO47759020Medicaid
I56368Medicare UPIN
COCOA107533Medicare PIN
CO47759020Medicaid