Healthcare Provider Details

I. General information

NPI: 1710842422
Provider Name (Legal Business Name): EDWARD T KIM MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 NEWPORT CENTER DR STE 704
NEWPORT BEACH CA
92660-8603
US

IV. Provider business mailing address

400 NEWPORT CENTER DR STE 704
NEWPORT BEACH CA
92660-8603
US

V. Phone/Fax

Practice location:
  • Phone: 949-785-6300
  • Fax: 949-785-6300
Mailing address:
  • Phone: 949-785-6300
  • Fax: 949-785-6300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: EDWARD T KIM
Title or Position: OWNER
Credential: MD
Phone: 630-248-5539