Healthcare Provider Details

I. General information

NPI: 1902711971
Provider Name (Legal Business Name): KIMJEM MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 08/15/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32869 STARLIGHT ST
WILDOMAR CA
92595-8085
US

IV. Provider business mailing address

32869 STARLIGHT ST
WILDOMAR CA
92595-8085
US

V. Phone/Fax

Practice location:
  • Phone: 562-318-4492
  • Fax:
Mailing address:
  • Phone: 562-318-4492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number
License Number State

VIII. Authorized Official

Name: IRENE VILLAREAL
Title or Position: COO
Credential:
Phone: 562-318-4492