Healthcare Provider Details

I. General information

NPI: 1841352663
Provider Name (Legal Business Name): JIM C. KIM, M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2203 17TH ST
BAKERSFIELD CA
93301-3634
US

IV. Provider business mailing address

2203 17TH ST
BAKERSFIELD CA
93301-3634
US

V. Phone/Fax

Practice location:
  • Phone: 661-716-0333
  • Fax: 661-716-1288
Mailing address:
  • Phone: 661-716-0333
  • Fax: 661-716-1288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberA067383
License Number StateCA

VIII. Authorized Official

Name: JIM C. KIM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 661-716-0333