Basic Information
Provider Information
NPI: 1841373594
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KIM
FirstName: HYE KYUNG
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
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OtherCredential:  
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Mailing Information
Address1: 50 DOUGLAS DRIVE SUITE 391
Address2: HEALTH SERVICES ADMINISTRATION
City: MARTINEZ
State: CA
PostalCode: 945534098
CountryCode: US
TelephoneNumber: 9259575429
FaxNumber: 9259575401
Practice Location
Address1: 2500 ALHAMBRA AVENUE
Address2: CONTRA COSTA REGIONAL MEDICAL CENTER AND HEALTH CENTERS
City: MARTINEZ
State: CA
PostalCode: 945533156
CountryCode: US
TelephoneNumber: 9253705110
FaxNumber: 9253705142
Other Information
ProviderEnumerationDate: 10/23/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207ZP0105XA30584CAY Allopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine

No ID Information.


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