MEDICARE: HONG S. KIM, MD, INC

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	314000000X	Skilled Nursing Facility	NP95000876	CA

General Provider Information

NPI Number	:	1336541697
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HONG S. KIM, MD, INC

Provider Business Mailing Address
First Line	:	12665 GARDEN GROVE BLVD STE 503
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-1919
Country	:	US
Telephone Number	:	714-530-3740
Fax Number	:

Provider Business Practice Location Address
First Line	:	12665 GARDEN GROVE BLVD STE 503
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-1919
Country	:	US
Telephone Number	:	714-530-3740
Fax Number	:

Authorized Official
Title or Position	:	MD/PRESIDENT
Name	:	DR. HONG S. KIM
Credential	:	MD
Telephone Number	:	714-530-3740

Provider Enumeration Date	:	09/18/2014
Last Update Date	:	09/18/2014

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