MEDICARE: MIN KYUNG KIM PA-C

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	363A00000X	Physician Assistant	52129	CA

General Provider Information

NPI Number	:	1841697513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIN KYUNG KIM PA-C

Provider Business Mailing Address
First Line	:	2600 VIA DE LA VALLE STE 200
Second Line	:
City	:	DEL MAR
State	:	CA
Zip	:	92014-1992
Country	:	US
Telephone Number	:	858-499-2708
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 VIA DE LA VALLE STE 200
Second Line	:
City	:	DEL MAR
State	:	CA
Zip	:	92014-1992
Country	:	US
Telephone Number	:	858-499-2708
Fax Number	:

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

Provider Enumeration Date	:	11/25/2014
Last Update Date	:	06/09/2026

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