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General NPI Number Information
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NPI Number | 1740795079
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Entity Type | Organization
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Legal Business Name | MICHAEL J KIM, MD, INC.
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Dates
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Enumeration Date | 12/08/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 3500 BARRANCA PKWY STE 130
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City | IRVINE
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State | CA
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Zip | 92606-8227
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Country | US
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Telephone | 949-552-6266
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Fax | 714-347-1081
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Provider Business Mailing Address
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Address Line | 210 N TUSTIN AVE
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City | SANTA ANA
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State | CA
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Zip | 92705-3807
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Country | US
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Telephone | 714-347-1000
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Fax | 714-347-1081
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL JINWOO KIM
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Credential | MD
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Telephone | 562-774-5597
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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 | A116203
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License Number State | CA
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