Provider Demographics
NPI:1568807212
Name:KIM, BYUNGHEE KEVIN (DPM)
Entity Type:Individual
Prefix:
First Name:BYUNGHEE
Middle Name:KEVIN
Last Name:KIM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2299 POST ST 205
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3473
Mailing Address - Country:US
Mailing Address - Phone:510-289-6624
Mailing Address - Fax:800-808-1779
Practice Address - Street 1:1915 BISHOP LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1901
Practice Address - Country:US
Practice Address - Phone:502-459-3338
Practice Address - Fax:502-459-7509
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00401213E00000X
CAE5000213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000863362OtherANTHEM
KYP01291447OtherRAILROAD MEDICARE
KY7100267930Medicaid
KY50063970OtherPASSPORT HEALTH PLAN
KYP01291447OtherRAILROAD MEDICARE