Individual
DR. ILKYOON KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15666 18TH AVENUE, CLEARLAKE, CA 95422
(707) 994-4210
(707) 994-0839
Mailing address
PO BOX 5326, CLEARLAKE, CA 95422-5326
(707) 994-4210
(707) 994-0839
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
A34081
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A340810
—
CA
01
—
00A340811
BLUE SHIELD
CA
05
—
00A340811
—
CA
01
—
00A340812
BLUE SHIELD
CA
01
—
68-0068216
BLUE CROSS
—
01
—
A34081
LICENSE NUMBER
CA
Enumeration date
08/16/2006
Last updated
06/30/2014
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