Healthcare Provider Details

I. General information

NPI: 1720249691
Provider Name (Legal Business Name): JAMES ANTHONY KIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N TUSTIN AVE STE 507
SANTA ANA CA
92705-3609
US

IV. Provider business mailing address

801 N TUSTIN AVE STE 507
SANTA ANA CA
92705-3609
US

V. Phone/Fax

Practice location:
  • Phone: 949-566-8688
  • Fax: 949-566-8656
Mailing address:
  • Phone: 949-566-8688
  • Fax: 949-566-8656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA109521
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: