Provider Demographics
NPI:1518157585
Name:KIM, HYESUN (MD)
Entity Type:Individual
Prefix:MRS
First Name:HYESUN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 CORPORATE PARK STE 115
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-3131
Mailing Address - Country:US
Mailing Address - Phone:949-752-7575
Mailing Address - Fax:949-752-0077
Practice Address - Street 1:62 CORPORATE PARK STE 115
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-3131
Practice Address - Country:US
Practice Address - Phone:949-752-7575
Practice Address - Fax:949-752-0077
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA100945207R00000X, 174400000X
NVLL1828390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA100945OtherCA MEDICAL LICENCE
NVLL1828OtherNV MEDICAL LICENSE