MEDICARE: HONG SIK 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	207RN0300X	Nephrology Physician	A45579	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A455792	OTHER	CA	PRIVATE INSURANCES
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396727764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HONG SIK KIM M.D.

Provider Business Mailing Address
First Line	:	12665 GARDEN GROVE BLVD
Second Line	:	SUITE 503
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-1901
Country	:	US
Telephone Number	:	714-530-3740
Fax Number	:	714-530-0582

Provider Business Practice Location Address
First Line	:	12665 GARDEN GROVE BLVD
Second Line	:	SUITE 503
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-1901
Country	:	US
Telephone Number	:	714-530-3740
Fax Number	:	714-530-0582

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

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	11/07/2013

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Directions to “ HONG SIK KIM M.D.” Practice Location

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