MEDICARE: JUNG BONG KIM,MD,INC.

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

General Provider Information

NPI Number	:	1275863466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUNG BONG KIM,MD,INC.

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	:	PRESIDENT
Name	:	DR. JUNGBONG KIM
Credential	:	MD
Telephone Number	:	949-679-8762

Provider Enumeration Date	:	01/11/2010
Last Update Date	:	01/11/2010

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