Healthcare Provider Details

I. General information

NPI: 1841429404
Provider Name (Legal Business Name): ALEXANDER S KIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2009
Last Update Date: 06/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 GILMAN DR DEPT 635
LA JOLLA CA
92093-0635
US

IV. Provider business mailing address

9500 GILMAN DR DEPT 635
LA JOLLA CA
92093-0635
US

V. Phone/Fax

Practice location:
  • Phone: 619-335-8685
  • Fax:
Mailing address:
  • Phone: 619-335-8685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License Number125086
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP0989
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: