Provider Demographics
NPI:1689841207
Name:HYO J KIM MD PC
Entity Type:Organization
Organization Name:HYO J KIM MD PC
Other - Org Name:HEARTSCAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HYO
Authorized Official - Middle Name:J
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-928-7700
Mailing Address - Street 1:12 STONEGATE CT
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:CA
Mailing Address - Zip Code:94507-1745
Mailing Address - Country:US
Mailing Address - Phone:415-928-7700
Mailing Address - Fax:
Practice Address - Street 1:2161 YGNACIO VALLEY ROAD
Practice Address - Street 2:100
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3348
Practice Address - Country:US
Practice Address - Phone:925-939-3003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HYO J KIM MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40291261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
A48174Medicare UPIN