Healthcare Provider Details

I. General information

NPI: 1780690636
Provider Name (Legal Business Name): DUKE D KIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26302 LA PAZ RD
MISSION VIEJO CA
92691-5313
US

IV. Provider business mailing address

26302 LA PAZ RD STE 106
MISSION VIEJO CA
92691-5327
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 TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberA24150
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberA24150
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License NumberA24150
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: