Provider Demographics
NPI:1891978128
Name:KIM, YI SOO ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:YI SOO
Middle Name:ROBERT
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4700 POINT FOSDICK DR NW
Mailing Address - Street 2:SUITE 307
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1706
Mailing Address - Country:US
Mailing Address - Phone:253-857-8346
Mailing Address - Fax:253-857-0259
Practice Address - Street 1:4700 POINT FOSDICK DR NW
Practice Address - Street 2:SUITE 307
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1706
Practice Address - Country:US
Practice Address - Phone:253-857-8346
Practice Address - Fax:253-857-0259
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA789152086S0129X
WAMD600213522086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8875958Medicare PIN