Provider Demographics
NPI:1730262882
Name:KIM, JAMES Y (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:Y
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1325 N LITCHFIELD RD STE 130
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-1215
Mailing Address - Country:US
Mailing Address - Phone:602-249-8577
Mailing Address - Fax:480-581-9701
Practice Address - Street 1:1325 N LITCHFIELD RD STE 130
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-1215
Practice Address - Country:US
Practice Address - Phone:602-249-8577
Practice Address - Fax:480-581-9701
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ72935207RC0000X
GA046980207RC0000X
TXN9578207RC0000X, 207RI0011X
OH35.138845207RC0000X, 207RI0011X
FLME115431207RI0011X, 208M00000X
OK33301207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200343530BMedicaid
TX283455803Medicaid
TX283455802Medicaid
FL018227700Medicaid
AZ180793Medicaid
FLIC063YMedicare UPIN
TX283455803Medicaid