Healthcare Provider Details

I. General information

NPI: 1740795079
Provider Name (Legal Business Name): MICHAEL J KIM, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 BARRANCA PKWY STE 130
IRVINE CA
92606-8227
US

IV. Provider business mailing address

210 N TUSTIN AVE
SANTA ANA CA
92705-3807
US

V. Phone/Fax

Practice location:
  • Phone: 949-552-6266
  • Fax: 714-347-1081
Mailing address:
  • Phone: 714-347-1000
  • Fax: 714-347-1081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA116203
License Number StateCA

VIII. Authorized Official

Name: MICHAEL JINWOO KIM
Title or Position: PRESIDENT
Credential: MD
Phone: 562-774-5597