Healthcare Provider Details

I. General information

NPI: 1992264964
Provider Name (Legal Business Name): IRIS KIM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3816 WOODRUFF AVE STE 209
LONG BEACH CA
90808-2145
US

IV. Provider business mailing address

385 S MANCHESTER AVE UNIT 1105
ORANGE CA
92868-3242
US

V. Phone/Fax

Practice location:
  • Phone: 562-496-4749
  • Fax: 562-429-3329
Mailing address:
  • Phone: 808-391-4258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1992264964
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberA180447
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: