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Contact Information

ILKYOON KIM, MD
15666 18TH AVENUE
CLEARLAKE, CA95422
 Phone: 707-994-4210
 Fax: 707-994-0839
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Cardiovascular Disease

207RC0000X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for ILKYOON KIM · (Male)

NPI # 1154434728
Status Active
Credentials MD
Entity Individual
Enumeration date 08/16/2006
Last updated 06/30/2014 - About 12 years ago
Sole proprietor 1 Yes
Identifiers
  • CA License # A34081
  • CA Medicaid 00A340810
  • CA Medicaid 00A340811
  • Other 68-0068216 BLUE CROSS
  • CA Other 00A340811 BLUE SHIELD
  • CA Other 00A340812 BLUE SHIELD
  • CA Other A34081 LICENSE NUMBER
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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