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General NPI Number Information
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NPI Number | 1073951190
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Entity Type | Individual
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Provider Name | MICHAEL JAE BUM KIM D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 06/11/2013
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Last Update Date | 02/23/2024
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Provider Practice Location Address
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Address Line | 9353 FAIRWAY VIEW PL STE 100
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-0972
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Country | US
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Telephone | 909-858-2772
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Fax | 909-300-6324
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Provider Business Mailing Address
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Address Line | 9353 FAIRWAY VIEW PL STE 100
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-0972
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Country | US
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Telephone | 909-858-2772
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Fax | 909-300-6324
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 5901002476
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | E5294
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License Number State | CA
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