Provider Demographics
NPI:1558528968
Name:KIM, WON (MD)
Entity Type:Individual
Prefix:DR
First Name:WON
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1600 DIVISADERO ST
Mailing Address - Street 2:BOX 1711
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3010
Mailing Address - Country:US
Mailing Address - Phone:415-885-7276
Mailing Address - Fax:415-353-7779
Practice Address - Street 1:1600 DIVISADERO ST
Practice Address - Street 2:BOX 1711
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3010
Practice Address - Country:US
Practice Address - Phone:415-885-7276
Practice Address - Fax:415-353-7779
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA115678207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program