Basic Information
| Provider Information | |||||||||
| NPI: | 1376707224 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | INAH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 W 8TH AVENUE | ||||||||
| Address2: | MOTHER GAMELIN BLDG, 3RD FLOOR, ROOM 207305 | ||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 99204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094746842 | ||||||||
| FaxNumber: | 5094746606 | ||||||||
| Practice Location | |||||||||
| Address1: | 5633 N LIDGERWOOD ST | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 99208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099422909 | ||||||||
| FaxNumber: | 5092277070 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2008 | ||||||||
| LastUpdateDate: | 12/07/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | MD60549183 | WA | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207Q00000X | 12314 | ND | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 4301099770 | MI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD60549183 | WA | N | Allopathic & Osteopathic Physicians | Family Medicine | 208M00000X | 4301099770 | MI | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 12314 | ND | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 16960 | 05 | ND | MEDICAID | 1376707224 | 05 | WA | MEDICAID |