Provider Demographics
NPI:1629033535
Name:KIM, SAEKYU ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:SAEKYU
Middle Name:ROBERT
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 1:444 BRUCE ST
Mailing Address - Street 2:
Mailing Address - City:YREKA
Mailing Address - State:CA
Mailing Address - Zip Code:96097-3450
Mailing Address - Country:US
Mailing Address - Phone:530-841-6313
Mailing Address - Fax:530-841-6334
Practice Address - Street 1:475 BRUCE ST
Practice Address - Street 2:
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097-3474
Practice Address - Country:US
Practice Address - Phone:530-841-6313
Practice Address - Fax:530-841-6334
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042435208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACG054ZOtherPTAN MEDICARE
CA1629033535Medicaid
WA1118645Medicaid
CA1629033535Medicaid
WA1118645Medicaid