1407144686 NPI number — DR. JOOHYUN KIM MD, PHD

Table of content: DR. JOOHYUN KIM MD, PHD (NPI 1407144686)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407144686 NPI number — DR. JOOHYUN KIM MD, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIM
Provider First Name:
JOOHYUN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407144686
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/28/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9200 W WISCONSIN AVE
Provider Second Line Business Mailing Address:
SUITE E5700, MCW TRANSPLANT SURGERY
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53226-3522
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-805-6400
Provider Business Mailing Address Fax Number:
414-955-0213

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 HOWARD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06519-1369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-785-6214
Provider Business Practice Location Address Fax Number:
203-785-3346
Provider Enumeration Date:
07/21/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 204F00000X , with the licence number:  60765-20 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 204F00000X , with the licence number: 80475 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1407144686 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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