DR. ILKYOON KIM M.D. NPI 1154434728

NPI Information

NPI: 1154434728
Provider Name: DR. ILKYOON KIM, M.D.
Classification: Internal Medicine - 207RC0000X
Entity Type: Individual

Specialization: Cardiovascular Disease

Address:
15666 18TH AVENUE
CLEARLAKE, CA
ZIP 95422
Phone: (707) 994-4210
Get Directions

DR. Ilkyoon Kim, M.D. is a cardiovascular disease internal medicine in Clearlake, CA. The provider is an internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. DR. Ilkyoon Kim, M.D. NPI is 1154434728. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

15666 18TH AVENUE
CLEARLAKE, CA
ZIP 95422
Phone: (707) 994-4210
Fax: (707) 994-0839

The enumeration date for this NPI number is 8/16/2006 and was last updated on 6/30/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207RC0000X	Internal Medicine	Cardiovascular Disease	A34081	CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	A88038	MEDICARE UPIN
2	68-0068216	OTHER		TIN
3	00A340811	OTHER	CALIFORNIA	BLUE SHIELD
4	A34081	OTHER	CALIFORNIA	LICENSE NUMBER
5	00A340810	MEDICAID	CALIFORNIA
6	68-0068216	OTHER		BLUE CROSS
7	00A340811	MEDICAID	CALIFORNIA
8	00A340812	OTHER	CALIFORNIA	BLUE SHIELD
9	00A340810	MEDICARE PIN	CALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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