Healthcare Provider Details

I. General information

NPI: 1316124431
Provider Name (Legal Business Name): KIM CHONG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIM HUYNH M.D.

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9449 IMPERIAL HWY
DOWNEY CA
90242-2814
US

IV. Provider business mailing address

PO BOX 3816
ALHAMBRA CA
91803-0816
US

V. Phone/Fax

Practice location:
  • Phone: 800-823-4040
  • Fax:
Mailing address:
  • Phone: 909-996-1329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA100213
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: