Healthcare Provider Details

I. General information

NPI: 1346282308
Provider Name (Legal Business Name): MICHAEL K. KIM, M.D., A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 KATELLA AVE SUITE 414
LOS ALAMITOS CA
90720-3338
US

IV. Provider business mailing address

3801 KATELLA AVE SUITE 414
LOS ALAMITOS CA
90720-3338
US

V. Phone/Fax

Practice location:
  • Phone: 562-430-6065
  • Fax: 562-430-6069
Mailing address:
  • Phone: 562-430-6065
  • Fax: 562-430-6069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberA86558
License Number StateCA

VIII. Authorized Official

Name: MICHAEL K. KIM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 562-430-6065