Provider Demographics
NPI:1588862700
Name:KIM, AUSTIN H
Entity type:Individual
Prefix:MR
First Name:AUSTIN
Middle Name:H
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6380 TUPELO DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95621-1778
Mailing Address - Country:US
Mailing Address - Phone:916-721-7518
Mailing Address - Fax:916-721-4529
Practice Address - Street 1:6380 TUPELO DR
Practice Address - Street 2:SUITE 4
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95621-1778
Practice Address - Country:US
Practice Address - Phone:916-721-7518
Practice Address - Fax:916-721-4529
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies