Basic Information
| Provider Information | |||||||||
| NPI: | 1073775748 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | SOOHYUN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1191 E HERNDON AVE STE 102 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937203164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5597021390 | ||||||||
| FaxNumber: | 8085322240 | ||||||||
| Practice Location | |||||||||
| Address1: | 1191 E HERNDON AVE STE 102 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937203164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5597021390 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2008 | ||||||||
| LastUpdateDate: | 05/13/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | MD-19691 | HI | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
No ID Information.