Provider Demographics
NPI:1588636203
Name:KIM, KYONG-MEE S (MD)
Entity Type:Individual
Prefix:
First Name:KYONG-MEE
Middle Name:S
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 1:1688 WILLOW ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-5109
Mailing Address - Country:US
Mailing Address - Phone:408-448-2817
Mailing Address - Fax:408-448-4807
Practice Address - Street 1:1688 WILLOW ST
Practice Address - Street 2:SUITE C
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5109
Practice Address - Country:US
Practice Address - Phone:408-448-2817
Practice Address - Fax:408-448-4807
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA774942080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A774940Medicaid
CA00A774940Medicaid