Basic Information
| Provider Information | |||||||||
| NPI: | 1871532051 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | KAP-SOO | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10470 OLD PLACERVILLE RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958272539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004700071 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2800 L STREET | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958167098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164533300 | ||||||||
| FaxNumber: | 9164533313 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2006 | ||||||||
| LastUpdateDate: | 07/28/2015 | ||||||||
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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 | 207R00000X | MD00044497 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0000X | MD00044497 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology | 207RX0202X | MD00044497 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 207R00000X | G88900 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0003X | G88900 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 8416448 | 05 | WA | MEDICAID | 5339KI | 01 | REGENCE BLUE SHIELD | OTHER | 5596153 | 01 | AETNA | OTHER | BK7995028 | 01 | DEA | OTHER | P00185603 | 01 | RAILROAD MEDICARE | OTHER | 193335 | 01 | WA | LABOR & INDUSTRIES | OTHER | 3733057 | 01 | AETNA | OTHER |