Healthcare Provider Details

I. General information

NPI: 1093502148
Provider Name (Legal Business Name): KYK MEDICAL PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13522 NEWPORT AVE STE 102
TUSTIN CA
92780-3707
US

IV. Provider business mailing address

3712 AVENUE SAUSALITO
IRVINE CA
92606-1849
US

V. Phone/Fax

Practice location:
  • Phone: 714-388-6816
  • Fax: 832-406-3968
Mailing address:
  • Phone: 714-388-6816
  • Fax: 832-406-3968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KI-YOON KIM
Title or Position: OWNER
Credential: MD
Phone: 714-388-6816