Healthcare Provider Details

I. General information

NPI: 1194501478
Provider Name (Legal Business Name): JASON Y KIM MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2023
Last Update Date: 09/04/2023
Certification Date: 09/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 SAN GABRIEL LN
PLACENTIA CA
92870-6221
US

IV. Provider business mailing address

218 SAN GABRIEL LN
PLACENTIA CA
92870-6221
US

V. Phone/Fax

Practice location:
  • Phone: 714-883-6751
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JASON YOUNG KIM
Title or Position: CEO
Credential: MD
Phone: 714-883-6751