Healthcare Provider Details

I. General information

NPI: 1467393421
Provider Name (Legal Business Name): DR. CHRISTINA KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 SIERRA MADRE VILLA AVE STE 110
PASADENA CA
91107-2000
US

IV. Provider business mailing address

5999 MIRA VISTA LN
FONTANA CA
92336-5806
US

V. Phone/Fax

Practice location:
  • Phone: 800-423-9591
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: