Healthcare Provider Details

I. General information

NPI: 1285913012
Provider Name (Legal Business Name): SUZY KIM MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2011
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2767 EAST IMPERIAL HIGHWAY ST. JUDE CENTER FOR REHABILITATION & WELLNESS
BREA CA
92821
US

IV. Provider business mailing address

5 JOURNEY STE 210
ALISO VIEJO CA
92656-5332
US

V. Phone/Fax

Practice location:
  • Phone: 714-578-8720
  • Fax: 714-578-8713
Mailing address:
  • Phone: 949-305-7122
  • Fax: 949-305-7160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberA86559
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: SUZY KIM
Title or Position: PHYSICIAN
Credential: MD
Phone: 650-793-6444