Basic Information
| Provider Information | |||||||||
| NPI: | 1235766569 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | SHAWN | ||||||||
| MiddleName: | KYUNGSUN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3551 ROGER BROOKE DR. | ||||||||
| Address2: | SAMMC, MCHE-ZDM-M, INTERNAL MEDICINE RESIDENCY | ||||||||
| City: | JBSA-FORT SAM HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78234 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3551 ROGER BROOKE DR. | ||||||||
| Address2: | SAMMC, MCHE-ZDM-M, INTERNAL MEDICINE RESIDENCY | ||||||||
| City: | JBSA-FORT SAM HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102927805 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2020 | ||||||||
| LastUpdateDate: | 04/01/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 0101274609 | VA | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.