MEDICARE: ILDONG 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	208000000X	Pediatrics Physician	A068315	CA
2	207R00000X	Internal Medicine Physician	A068315	CA

General Provider Information

NPI Number	:	1346262896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILDONG KIM M.D.

Provider Business Mailing Address
First Line	:	3762 CLAIREMONT DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-5916
Country	:	US
Telephone Number	:	858-560-8910
Fax Number	:	858-560-8011

Provider Business Practice Location Address
First Line	:	3762 CLAIREMONT DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-5916
Country	:	US
Telephone Number	:	858-560-8910
Fax Number	:	858-560-8011

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	02/08/2024

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Directions to “ ILDONG KIM M.D.” Practice Location

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