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General NPI Number Information
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NPI Number | 1629267943
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Entity Type | Organization
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Legal Business Name | TCHANG JUN KIM MD INC
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Dates
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Enumeration Date | 10/23/2007
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Last Update Date | 08/22/2014
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Provider Practice Location Address
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Address Line | 12601 GARDEN GROVE BLVD
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City | GARDEN GROVE
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State | CA
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Zip | 92843-1908
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Country | US
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Telephone | 714-537-5160
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Fax | 714-590-2489
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Provider Business Mailing Address
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Address Line | PO BOX 775
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City | GARDEN GROVE
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State | CA
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Zip | 92842-0775
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Country | US
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Telephone | 714-636-0342
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Fax | 714-636-0342
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TCHANG JUN KIM
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Credential | M. D.
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Telephone | 714-636-0342
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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 | A29337
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License Number State | CA
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