Healthcare Provider Details

I. General information

NPI: 1235451360
Provider Name (Legal Business Name): JANET BONNIE KIM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2010
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

26302 LA PAZ RD #106 STE 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 NumberG82040
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: