Provider Demographics
NPI:1124078282
Name:KIM, HAN SOO (MD)
Entity type:Individual
Prefix:
First Name:HAN
Middle Name:SOO
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1206
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93116-1206
Mailing Address - Country:US
Mailing Address - Phone:805-964-3838
Mailing Address - Fax:805-683-3400
Practice Address - Street 1:1325 E CHURCH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454
Practice Address - Country:US
Practice Address - Phone:805-346-3456
Practice Address - Fax:805-347-3457
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2024-02-27
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Provider Licenses
StateLicense IDTaxonomies
CAA92762208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1124078282Medicare PIN