MEDICARE: HONG S. 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	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A45579	OTHER	CA	DR LIC

General Provider Information

NPI Number	:	1619649761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HONG S. KIM MD, INC

Provider Business Mailing Address
First Line	:	12665 GARDEN GROVE BLVD STE 503
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-1919
Country	:	US
Telephone Number	:	714-530-3740
Fax Number	:	714-530-0582

Provider Business Practice Location Address
First Line	:	12665 GARDEN GROVE BLVD STE 503
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-1919
Country	:	US
Telephone Number	:	714-530-3740
Fax Number	:	714-530-0582

Authorized Official
Title or Position	:	PRESIDENT /MD
Name	:	HONG S KIM
Credential	:	MD
Telephone Number	:	714-530-3740

Provider Enumeration Date	:	09/28/2021
Last Update Date	:	09/30/2021

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