Healthcare Provider Details

I. General information

NPI: 1790282416
Provider Name (Legal Business Name): HANNA KIM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 JAMBOREE RD STE 1100
NEWPORT BEACH CA
92660-2956
US

IV. Provider business mailing address

3501 JAMBOREE RD STE 1100
NEWPORT BEACH CA
92660-2956
US

V. Phone/Fax

Practice location:
  • Phone: 949-222-1290
  • Fax:
Mailing address:
  • Phone: 949-222-1290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35.145119
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberA203860
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: