Healthcare Provider Details

I. General information

NPI: 1932902251
Provider Name (Legal Business Name): NATHAN THOMAS YONGKI KIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL PLAZA DR
ROSEVILLE CA
95661-3037
US

IV. Provider business mailing address

10940 CLEMENTINE WAY
LOMA LINDA CA
92354-6104
US

V. Phone/Fax

Practice location:
  • Phone: 916-292-0294
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA210832
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: