Provider Demographics
NPI:1760423354
Name:KIM, DUK HWAN (MD)
Entity Type:Individual
Prefix:
First Name:DUK
Middle Name:HWAN
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8622 MASTERS DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-4524
Mailing Address - Country:US
Mailing Address - Phone:714-855-4989
Mailing Address - Fax:714-418-5789
Practice Address - Street 1:8622 MASTERS DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-4524
Practice Address - Country:US
Practice Address - Phone:714-855-4989
Practice Address - Fax:714-418-5789
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA785462084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00605841OtherRAILROAD MEDICARE
CAW6126OtherMEDICARE GROUP PTAN
ND17887Medicaid
CA00A785460Medicaid
ND17887Medicaid