Individual
MARK S. KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1803 S MERIDIAN, PUYALLUP, WA 98371
(253) 268-3400
(253) 268-3870
Mailing address
1803 S MERIDIAN, PUYALLUP, WA 98371-7513
(253) 589-6573
(253) 984-1079
Taxonomy
Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
Primary
MD00038816
WA
207Q00000X
Family Medicine Physician
MD00038816
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8255697
—
WA
Enumeration date
09/29/2006
Last updated
01/15/2019
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