Provider Demographics
NPI:1518188499
Name:KIM, HYOSHIN (ND)
Entity Type:Individual
Prefix:
First Name:HYOSHIN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:DERRICK
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ND
Mailing Address - Street 1:11545 SW DURHAM RD
Mailing Address - Street 2:B-9
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-3473
Mailing Address - Country:US
Mailing Address - Phone:503-639-0778
Mailing Address - Fax:
Practice Address - Street 1:11545 SW DURHAM RD
Practice Address - Street 2:B-9
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-3473
Practice Address - Country:US
Practice Address - Phone:503-639-0778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1251175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath