MEDICARE: JASON H H KIM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	000000A75011	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A75011	OTHER	CA	LICENSE

General Provider Information

NPI Number	:	1225118979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON H H KIM MD

Provider Business Mailing Address
First Line	:	1950 SUNNY CREST DR STE 2700
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92835-3645
Country	:	US
Telephone Number	:	714-519-3545
Fax Number	:	714-870-0000

Provider Business Practice Location Address
First Line	:	1950 SUNNY CREST DR STE 2700
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92835-3645
Country	:	US
Telephone Number	:	714-519-3545
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	03/11/2019

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