Provider Demographics
NPI:1891885307
Name:KIM, HYUN JOO (MD)
Entity Type:Individual
Prefix:
First Name:HYUN JOO
Middle Name:
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 1:420 DELAWARE ST SE MMC 276
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-626-6100
Mailing Address - Fax:
Practice Address - Street 1:516 DELAWARE ST SE
Practice Address - Street 2:PWB 2ND FLOOR, CLINIC 2A
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0356
Practice Address - Country:US
Practice Address - Phone:612-626-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN34868207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN107080OtherU CARE
290006569OtherRR MEDICARE
MN304765200Medicaid
MN4829940OtherMEDICA-CHOICE
MN1010342OtherPREFERRED ONE
604701OtherARAZ
MN088948OtherFAIRVIEW
MN9D244KIOtherBCBS
MN48-00006OtherMEDICA-PRIMARY
MNHP22244OtherHEALTH PARTNERS
MN304765200Medicaid
604701OtherARAZ
MT0058669Medicare ID - Type UnspecifiedMT MA