Provider Demographics
NPI:1679736854
Name:KIM, ALICE MAY (DO)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:MAY
Last Name:KIM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WOODSIDE CT
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-1139
Mailing Address - Country:US
Mailing Address - Phone:510-292-8199
Mailing Address - Fax:
Practice Address - Street 1:221 E CULLERTON ST
Practice Address - Street 2:APT 1021
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-1386
Practice Address - Country:US
Practice Address - Phone:510-292-8199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A12182207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine