Individual
KYONG HO KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
11306 BRIDGEPORT WAY SW, SUITE D, LAKEWOOD, WA 98499-3037
(253) 983-9390
(253) 983-0066
Mailing address
PO BOX 39324, LAKEWOOD, WA 98496-3324
(253) 983-9390
(253) 983-0066
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
OP00001595
WA
208VP0014X
Interventional Pain Medicine Physician
Primary
OP00001595
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1002900
—
WA
Enumeration date
11/07/2005
Last updated
02/15/2023
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