Provider Demographics
NPI:1144717323
Name:KIM, NATHAN GEONWOO (MD)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:GEONWOO
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 BROADWAY ST
Mailing Address - Street 2:PAVILION C, 3RD FLOOR, GI, MC 6341
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063
Mailing Address - Country:US
Mailing Address - Phone:650-736-5555
Mailing Address - Fax:
Practice Address - Street 1:430 BROADWAY ST
Practice Address - Street 2:PAVILION C, 3RD FLOOR, GI, MC 6341
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063
Practice Address - Country:US
Practice Address - Phone:650-736-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-13
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA173606207RG0100X, 207RT0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RT0003XAllopathic & Osteopathic PhysiciansInternal MedicineTransplant HepatologyGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty