Provider Demographics
NPI:1477557890
Name:KIM, JOSEPH HYON-BAE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:HYON-BAE
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 1:175 S UNION BLVD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-3113
Mailing Address - Country:US
Mailing Address - Phone:719-633-5515
Mailing Address - Fax:719-471-2258
Practice Address - Street 1:175 S UNION BLVD
Practice Address - Street 2:STE 350
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3146
Practice Address - Country:US
Practice Address - Phone:719-633-5515
Practice Address - Fax:719-471-2258
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32551207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01325513Medicaid
COCS8738Medicare PIN
COF35174Medicare UPIN
COCC9314Medicare PIN