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General NPI Number Information
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NPI Number | 1699948265
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Entity Type | Individual
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Provider Name | WONHA KIM M.D., M.P.H.
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Gender | Female
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Dates
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Enumeration Date | 04/03/2008
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Last Update Date | 10/01/2013
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Provider Practice Location Address
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Address Line | 25845 BARTON RD SUITE F
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City | LOMA LINDA
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State | CA
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Zip | 92354-3899
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Country | US
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Telephone | 443-812-5287
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Fax |
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Provider Business Mailing Address
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Address Line | 11175 CAMPUS ST COLEMAN PAVILLION ROOM A-1121
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City | LOMA LINDA
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State | CA
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Zip | 92350-1700
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Country | US
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Telephone | 443-812-5287
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A127117
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License Number State | CA
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