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General NPI Number Information
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NPI Number | 1356605836
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Entity Type | Individual
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Provider Name | JONGJIN KIM M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/28/2012
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Last Update Date | 10/28/2021
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Provider Practice Location Address
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Address Line | 5471 LA PALMA AVE
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City | LA PALMA
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State | CA
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Zip | 90623-1745
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Country | US
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Telephone | 714-752-6088
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Fax | 657-577-9135
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Provider Business Mailing Address
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Address Line | 145 VERSAILLES CIR APT D
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City | TOWSON
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State | MD
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Zip | 21204-6933
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Country | US
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Telephone | 443-862-6573
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A133928
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License Number State | CA
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