Healthcare Provider Details

I. General information

NPI: 1114007697
Provider Name (Legal Business Name): JANET B. KIM, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26302 LA PAZ RD #106
MISSION VIEJO CA
92691-5380
US

IV. Provider business mailing address

26302 LA PAZ RD #106
MISSION VIEJO CA
92691-5380
US

V. Phone/Fax

Practice location:
  • Phone: 949-328-9972
  • Fax: 949-328-9976
Mailing address:
  • Phone: 949-328-9972
  • Fax: 949-328-9976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. JANET BONNIE KIM
Title or Position: OWNER
Credential: MD
Phone: 949-328-9972