Healthcare Provider Details

I. General information

NPI: 1508820531
Provider Name (Legal Business Name): SUZY KIM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2767 E IMPERIAL HWY
BREA CA
92821-6713
US

IV. Provider business mailing address

5 JOURNEY STE 210
ALISO VIEJO CA
92656-5332
US

V. Phone/Fax

Practice location:
  • Phone: 714-578-8706
  • Fax: 714-578-8715
Mailing address:
  • Phone: 949-305-7122
  • Fax: 949-305-7160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA86559
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License NumberA86559
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: