Same

LBN: Ilkyoon Kim Md A Prof Corp
Same is an health care organization with primary practice located at 15666 18Th Ave , Clearlake CA 95422-9336. The organization recently has only one registered license in Managed Care Organizations / Exclusive Provider Organization, which is considered as the primary health care specialty. Ilkyoon Kim Md A Prof Corp can be contacted via phone (707) 994-4210, or through Kim, Ilkyoon via phone (707) 994-4210.

Contact Information

Primary practice address
15666 18Th Ave Clearlake CA 95422-9336
Phone: (707) 994-4210
Fax: (707) 994-0839
Website:
Map and Directions
Authorized official contact:
Name: Kim, Ilkyoon Doctor of Medicine (MD)
Phone: (707) 994-4210

Health care specialties

SpecialtyCodeLicense #State
Managed Care Organizations / Exclusive Provider Organization 302F00000X A-34081 California

Profile Details

NPI number 1659516094
LBN Legal business name Ilkyoon Kim Md A Prof Corp
DBA Doing business as Same
Authorized official Kim, Ilkyoon Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 Yes
Enumeration date Dec 15th, 2008
Last updated Apr 12th, 2013 - about 11 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1659516094 NPPES
California MEDICAID 00A340810

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