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General NPI Number Information
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NPI Number | 1275863466
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Entity Type | Organization
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Legal Business Name | JUNG BONG KIM,MD,INC.
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Dates
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Enumeration Date | 01/11/2010
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Last Update Date | 01/11/2010
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Provider Practice Location Address
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Address Line | 4 LONGBOURN AISLE
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City | IRVINE
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State | CA
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Zip | 92603-5722
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Country | US
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Telephone | 949-679-8762
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Fax | 949-679-8762
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Provider Business Mailing Address
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Address Line | 4 LONGBOURN AISLE
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City | IRVINE
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State | CA
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Zip | 92603-5722
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Country | US
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Telephone | 949-679-8762
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Fax | 949-679-8762
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JUNGBONG KIM
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Credential | MD
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Telephone | 949-679-8762
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | A100599
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License Number State | CA
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