Provider Demographics
NPI:1467504712
Name:KIM, MAN K (MD)
Entity Type:Individual
Prefix:
First Name:MAN
Middle Name:K
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:PO BOX 34581
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1581
Mailing Address - Country:US
Mailing Address - Phone:509-241-7349
Mailing Address - Fax:509-241-7628
Practice Address - Street 1:310 15TH AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-5103
Practice Address - Country:US
Practice Address - Phone:206-326-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00027339207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8135683Medicaid
WA990004003Medicare PIN
WAA51895Medicare UPIN
WAGAB19090Medicare PIN
WAGAB19092Medicare PIN
WA8135683Medicaid
WAGAB28559Medicare PIN
WAG000135738Medicare PIN
WAG8880602Medicare PIN
WAGAB19091Medicare PIN
WAGAB28558Medicare PIN
WAGAB28557Medicare PIN