Provider Demographics
NPI:1871532051
Name:KIM, BRIAN KAP-SOO (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:KAP-SOO
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 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:2800 L STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-7098
Practice Address - Country:US
Practice Address - Phone:916-453-3300
Practice Address - Fax:916-453-3313
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044497207R00000X, 207RH0000X, 207RX0202X
CAG88900207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8416448Medicaid
5339KIOtherREGENCE BLUE SHIELD
5596153OtherAETNA
P00185603OtherRAILROAD MEDICARE
WA193335OtherLABOR & INDUSTRIES
3733057OtherAETNA
3733057OtherAETNA
WAG8853800Medicare PIN
WAG8853838Medicare PIN
WA193335OtherLABOR & INDUSTRIES
BK7995028OtherDEA
WAG8856861Medicare PIN
5596153OtherAETNA
WAG8851023Medicare PIN