Healthcare Provider Details

I. General information

NPI: 1134742703
Provider Name (Legal Business Name): DESERT PHYSICIANS MEDICAL GROUP HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2020
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 E TACHEVAH DR STE 1E204
PALM SPRINGS CA
92262-5733
US

IV. Provider business mailing address

555 E TACHEVAH DR STE 2W103
PALM SPRINGS CA
92262-5748
US

V. Phone/Fax

Practice location:
  • Phone: 760-424-8731
  • Fax: 760-424-8719
Mailing address:
  • Phone: 760-285-5013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: TAE KIM
Title or Position: CEO
Credential: MD
Phone: 760-285-5013