Provider Demographics
NPI:1881881787
Name:KIM, BRIAN S
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:S
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 LAWRENCE EXPY
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-5173
Mailing Address - Country:US
Mailing Address - Phone:650-400-0531
Mailing Address - Fax:
Practice Address - Street 1:700 LAWRENCE EXPY
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-5173
Practice Address - Country:US
Practice Address - Phone:650-400-0531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA922542085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A922540OtherBC/BS
CA1881881787Medicaid
CABI607TMedicare PIN
CABI607RMedicare PIN
CABI607UMedicare PIN
CA00A922540OtherBC/BS
CABI607VMedicare PIN
CABI607OMedicare PIN
CABI607ZMedicare PIN
CABI607YMedicare PIN
CABI607WMedicare PIN
CABI607XMedicare PIN
CABI607PMedicare PIN