Provider Demographics
NPI:1457303372
Name:EDSEL U. KIM, M.D. LLC
Entity Type:Organization
Organization Name:EDSEL U. KIM, M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EDSEL
Authorized Official - Middle Name:U
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-222-3638
Mailing Address - Street 1:2222 NW LOVEJOY
Mailing Address - Street 2:SUITE 607
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210
Mailing Address - Country:US
Mailing Address - Phone:503-222-3638
Mailing Address - Fax:503-223-5139
Practice Address - Street 1:2222 NW LOVEJOY
Practice Address - Street 2:SUITE 607
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210
Practice Address - Country:US
Practice Address - Phone:503-222-3638
Practice Address - Fax:503-223-5139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24541174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR226996Medicaid
ORG78086Medicare UPIN