Healthcare Provider Details

I. General information

NPI: 1225187388
Provider Name (Legal Business Name): JAMIE E KIM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 09/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18111 BROOKHURST ST #4450
FOUNTAIN VALLEY CA
92708
US

IV. Provider business mailing address

18111 BROOKHURST ST #4450
FOUNTAIN VALLEY CA
92708
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:
Title or Position:
Credential:
Phone: