Provider Demographics
NPI:1447577333
Name:KIM, DONG HYUN
Entity Type:Individual
Prefix:
First Name:DONG
Middle Name:HYUN
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2593 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-5111
Mailing Address - Country:US
Mailing Address - Phone:801-479-9711
Mailing Address - Fax:801-479-9711
Practice Address - Street 1:2593 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-5111
Practice Address - Country:US
Practice Address - Phone:801-479-9711
Practice Address - Fax:801-479-9711
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-01
Last Update Date:2010-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT163262-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT2598437767OtherUTAH STATE PROVIDER NUMBERS