Healthcare Provider Details

I. General information

NPI: 1326457839
Provider Name (Legal Business Name): MICHAEL H. KIM-ORDEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2014
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18035 BROOKHURST ST # 1100
FOUNTAIN VALLEY CA
92708-6738
US

IV. Provider business mailing address

6230 IRVINE BLVD # 338
IRVINE CA
92620-2103
US

V. Phone/Fax

Practice location:
  • Phone: 714-861-4888
  • Fax: 714-861-4777
Mailing address:
  • Phone: 949-274-9621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD61054853
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberMD61054853
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberA138771
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: