MEDICARE: JUNGBONG KIM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	A100599	CA
2	207L00000X	Anesthesiology Physician	2385861	NY

General Provider Information

NPI Number	:	1255429510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUNGBONG KIM M.D.

Provider Business Mailing Address
First Line	:	4 LONGBOURN AISLE
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92603-5722
Country	:	US
Telephone Number	:	949-679-8762
Fax Number	:	949-679-8762

Provider Business Practice Location Address
First Line	:	4 LONGBOURN AISLE
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92603-5722
Country	:	US
Telephone Number	:	949-679-8762
Fax Number	:	949-679-8762

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	06/11/2012

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