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General NPI Number Information
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NPI Number | 1053448373
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Entity Type | Organization
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Legal Business Name | YOUNG RAE KIM MD INC
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 09/19/2007
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Provider Practice Location Address
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Address Line | 3010 W ORANGE AVE STE 407
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City | ANAHEIM
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State | CA
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Zip | 92804
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Country | US
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Telephone | 714-484-3781
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Fax | 714-484-3852
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Provider Business Mailing Address
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Address Line | 3010 W ORANGE AVE STE 407
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City | ANAHEIM
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State | CA
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Zip | 92804-3173
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Country | US
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Telephone | 714-484-3781
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Fax | 714-484-3852
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Authorized Official
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Title or Position | PRESIDENT
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Name | YOUNG RAE KIM
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Credential | MEDICAL DIRECTOR
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Telephone | 714-484-3781
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A52615
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License Number State | CA
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