MEDICARE: HANA KIM D.O.

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	207Q00000X	Family Medicine Physician	20A12011	CA

General Provider Information

NPI Number	:	1699090522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANA KIM D.O.

Provider Business Mailing Address
First Line	:	17360 BROOKHURST ST
Second Line	:	ATTN: MCMF - CREDENTIALING DEPT.
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-3720
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18561 BEACH BLVD
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-2053
Country	:	US
Telephone Number	:	714-848-0080
Fax Number	:

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

Provider Enumeration Date	:	04/03/2010
Last Update Date	:	04/15/2021

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