Healthcare Provider Details

I. General information

NPI: 1265750954
Provider Name (Legal Business Name): JHKIM OD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2010
Last Update Date: 05/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9618 GARDEN GROVE BLVD STE 109
GARDEN GROVE CA
92844-1563
US

IV. Provider business mailing address

9618 GARDEN GROVE BLVD STE 109
GARDEN GROVE CA
92844-1563
US

V. Phone/Fax

Practice location:
  • Phone: 714-539-2020
  • Fax:
Mailing address:
  • Phone: 714-539-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEAN H KIM
Title or Position: PRESIDENT
Credential: O.D.
Phone: 714-539-2020