Provider Demographics
NPI: | 1568451649 |
---|---|
Name: | KIM, WALTER HYUN (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | WALTER |
Middle Name: | HYUN |
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: | 11000 N SCOTTSDALE RD STE 115 |
Mailing Address - Street 2: | |
Mailing Address - City: | SCOTTSDALE |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85254-6168 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 480-372-9497 |
Mailing Address - Fax: | 805-980-5535 |
Practice Address - Street 1: | 11000 N SCOTTSDALE RD STE 115 |
Practice Address - Street 2: | |
Practice Address - City: | SCOTTSDALE |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85254-6168 |
Practice Address - Country: | US |
Practice Address - Phone: | 480-372-9497 |
Practice Address - Fax: | 805-980-5535 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-10-20 |
Last Update Date: | 2021-10-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AZ | 64496 | 207RX0202X, 208D00000X |
CA | A86185 | 207UN0902X, 208D00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | |
No | 207RX0202X | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
No | 207UN0902X | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Imaging & Therapy |