Healthcare Provider Details

I. General information

NPI: 1053458828
Provider Name (Legal Business Name): DOCTORS OF OBGYN MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 WARNER AVE SUITE 160
FOUNTAIN VALLEY CA
92708-3207
US

IV. Provider business mailing address

8700 WARNER AVE SUITE 160
FOUNTAIN VALLEY CA
92708-3207
US

V. Phone/Fax

Practice location:
  • Phone: 714-848-2383
  • Fax: 714-848-4083
Mailing address:
  • Phone: 714-848-2383
  • Fax: 714-848-4083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG83581
License Number StateCA

VIII. Authorized Official

Name: DR. JAMIE E KIM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-848-2383