Provider Demographics
NPI:1700924719
Name:KIM, HYON SOO HAROLD (MD)
Entity type:Individual
Prefix:DR
First Name:HYON SOO HAROLD
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2230 NW PETTYGROVE ST
Mailing Address - Street 2:STE 120
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2659
Mailing Address - Country:US
Mailing Address - Phone:503-444-7676
Mailing Address - Fax:971-319-6647
Practice Address - Street 1:2230 NW PETTYGROVE ST
Practice Address - Street 2:STE 120
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2659
Practice Address - Country:US
Practice Address - Phone:503-444-7676
Practice Address - Fax:971-319-6647
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24993207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR022701Medicaid
OR022701Medicaid