Basic Information
| Provider Information | |||||||||
| NPI: | 1346336070 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | P. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3160 FOLSOM BLVD | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958165219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167333333 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3160 FOLSOM BLVD | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958165219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167333333 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A70418 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000810342721 | 01 | CA | PHCS | OTHER | 00A704180 | 01 | CA | BLUE SHIELD | OTHER | 1910455 | 01 | CA | FIRST HEALTH | OTHER | A70418 | 01 | CA | BLUE CROSS | OTHER | 5792195 | 01 | CA | CIGNA | OTHER | 089070 | 01 | CA | HEALTH NET | OTHER | 90121886 | 01 | CA | PACIFICARE | OTHER | 2144161 | 01 | CA | UNITED HEALTHCARE | OTHER | 7065251 | 01 | CA | AETNA | OTHER | 00A704180 | 05 | CA | MEDICAID | 49436 | 01 | CA | INTERPLAN | OTHER | MCMG128000 | 05 | CA | MEDICAID |