Organization
ILKYOON KIM MD A PROF CORP
Active
Parent organization
ILKYOON KIM MD A PROF CORP
Other names
same
Organization subpart
Yes
Provider details
NPI number
Legal business name
ILKYOON KIM MD A PROF CORP
Authorized official
DR. ILKYOON KIM MD (CEO)
(707) 994-4210
Entity
Organization
Contact information
Practice address
15666 18TH AVE, CLEARLAKE, CA 95422-9336
(707) 994-4210
(707) 994-0839
Mailing address
15666 18TH AVE, P.O. BOX 5326, CLEARLAKE, CA 95422-9336
(707) 994-4210
(707) 994-0839
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
A-34081
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A340810
—
CA
Enumeration date
12/15/2008
Last updated
04/12/2013
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