Provider Demographics
NPI:1962571943
Name:KIM, ELIZABETH MYONG-OK (MD)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:MYONG-OK
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5333 HOLLISTER AVE
Mailing Address - Street 2:SUITE 214
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2341
Mailing Address - Country:US
Mailing Address - Phone:805-967-0057
Mailing Address - Fax:805-967-7900
Practice Address - Street 1:5333 HOLLISTER AVE
Practice Address - Street 2:STE 295
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-2474
Practice Address - Country:US
Practice Address - Phone:805-967-0057
Practice Address - Fax:805-967-7900
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA043566207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE01680Medicare ID - Type UnspecifiedEIN NUMBER
CA770201725Medicare UPIN