Provider Demographics
NPI:1871740787
Name:KIM, MILTON W (MD)
Entity type:Individual
Prefix:
First Name:MILTON
Middle Name:W
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 1:746 MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501
Mailing Address - Country:US
Mailing Address - Phone:541-210-6365
Mailing Address - Fax:
Practice Address - Street 1:746 MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-4017
Practice Address - Country:US
Practice Address - Phone:541-210-6365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD28789208600000X
CO48188208600000X
MEMD19116208600000X
NMMD2012-0832208600000X
WAMD60271016208600000X
GUM-1787208600000X
WY9151A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery