Healthcare Provider Details

I. General information

NPI: 1275447773
Provider Name (Legal Business Name): PACIFIC GASTRO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 OVERBROOK
IRVINE CA
92620-2169
US

IV. Provider business mailing address

268 OVERBROOK
IRVINE CA
92620-2169
US

V. Phone/Fax

Practice location:
  • Phone: 714-388-6816
  • Fax: 832-406-3968
Mailing address:
  • Phone: 714-388-6816
  • Fax: 832-406-3968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: KI-YOON KIM
Title or Position: OWNER
Credential: MD
Phone: 714-388-6816