Provider Demographics
NPI:1912985169
Name:KIMM, SOON H (MD)
Entity Type:Individual
Prefix:DR
First Name:SOON
Middle Name:H
Last Name:KIMM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1207 N 200TH ST
Mailing Address - Street 2:STE 215
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-3213
Mailing Address - Country:US
Mailing Address - Phone:206-542-4257
Mailing Address - Fax:
Practice Address - Street 1:1306 N 175TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-5019
Practice Address - Country:US
Practice Address - Phone:206-542-7606
Practice Address - Fax:206-533-9880
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-06
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00022272207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1112747Medicaid
WA1112747Medicaid