Ilkyoon Kim MD a Prof Corp

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

License

A-34081 Issued in CA

Legal business name

ILKYOON KIM MD A PROF CORP

Doing business as

same

Practice address

15666 18TH Ave
Clearlake, CA 95422-9336

Phone

(707) 994-4210

Fax

(707) 994-0839

NPI assigned

Dec 15, 2008

Organization subpart

Yes

Parent organization

ILKYOON KIM MD A PROF CORPAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ilkyoon Kim, MD

Title

Ceo

Phone

(707) 994-4210

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• same Doing business as

Part of

Ilkyoon Kim MD

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Paul J Marks, MD

  • Pulmonary Disease Physician
  • Saint Helena, CA
  • NPI 1669454310
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1229299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365724800000",
    "number": "1659516094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15666 18TH AVE",
            "address_2": "P.O. BOX 5326",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "954229336",
            "telephone_number": "707-994-4210",
            "fax_number": "707-994-0839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15666 18TH AVE",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "954229336",
            "telephone_number": "707-994-4210",
            "fax_number": "707-994-0839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILKYOON KIM MD A PROF CORP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ILKYOON KIM MD A PROF CORP",
        "enumeration_date": "2008-12-15",
        "last_updated": "2013-04-12",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "ILKYOON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "707-994-4210",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "CA",
            "license": "A-34081",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A340810",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "same",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Karin Franziska Hudson, PSYD
• Laura Estefani Hurtado
• Stephanie Husted
• Gina Hutchins
• Huong Thu Huynh
• James William Isherwood III, LCSW
• Jack M. Elizares Optometric Corporation
• Claire Elise Jacobs
• Austin Jacquillard
• Jennifer a Dowalter MD a Professional Corporation

• Exclusive Provider Organization in Clearlake, CA
• Providers in Clearlake, CA by specialty
• Exclusive Provider Organization in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.