MEDICARE: DR. TOMMY YOUNGHO 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	2080P0204X	Pediatric Emergency Medicine (Pediatrics) Physician	A74005	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730172693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TOMMY YOUNGHO KIM M.D.

Provider Business Mailing Address
First Line	:	11234 ANDERSON ST
Second Line	:	A 108
City	:	LOMA LINDA
State	:	CA
Zip	:	92354-2804
Country	:	US
Telephone Number	:	909-558-4000
Fax Number	:

Provider Business Practice Location Address
First Line	:	11234 ANDERSON ST
Second Line	:	A 108
City	:	LOMA LINDA
State	:	CA
Zip	:	92354-2804
Country	:	US
Telephone Number	:	909-558-4000
Fax Number	:

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

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	07/19/2010

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