Healthcare Provider Details

I. General information

NPI: 1043912017
Provider Name (Legal Business Name): PRESTON KIM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16200 SAND CANYON AVE
IRVINE CA
92618-3714
US

IV. Provider business mailing address

11234 ANDERSON ST STE C
LOMA LINDA CA
92354-2804
US

V. Phone/Fax

Practice location:
  • Phone: 877-742-4624
  • Fax:
Mailing address:
  • Phone: 909-558-4074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA200842
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: