Provider Demographics
NPI:1487681102
Name:KIM, BENJAMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
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 1:1220 E 3900 S
Mailing Address - Street 2:4F
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1327
Mailing Address - Country:US
Mailing Address - Phone:801-268-8223
Mailing Address - Fax:801-268-8248
Practice Address - Street 1:1220 E 3900 S
Practice Address - Street 2:4F
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1327
Practice Address - Country:US
Practice Address - Phone:801-268-8223
Practice Address - Fax:801-268-8248
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1003810220208600000X, 2086X0206X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Not Answered2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Not Answered208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT45948OtherPEHP
UT1700075OtherUNITED HEALTH OF UTAH
UTQM0000033040OtherALTIUS
UTA16566Medicare UPIN