Provider Demographics
NPI:1770570293
Name:KIM, EUGENE M
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:M
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 E RIVER RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5877
Mailing Address - Country:US
Mailing Address - Phone:520-519-7775
Mailing Address - Fax:580-519-7910
Practice Address - Street 1:2222 E HIGHLAND AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4872
Practice Address - Country:US
Practice Address - Phone:602-277-4868
Practice Address - Fax:602-230-9350
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33968208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ933128Medicaid
AZ102930Medicare ID - Type Unspecified
AZI28649Medicare UPIN