Healthcare Provider Details

I. General information

NPI: 1699790899
Provider Name (Legal Business Name): KIM JAMES CHARNEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 W LA VETA AVE SUITE 620
ORANGE CA
92868-4223
US

IV. Provider business mailing address

1140 W LA VETA AVE SUITE 620
ORANGE CA
92868-4223
US

V. Phone/Fax

Practice location:
  • Phone: 714-550-0600
  • Fax: 714-550-9307
Mailing address:
  • Phone: 714-550-0600
  • Fax: 714-550-9307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA24258
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA24258
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberA24258
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: