MEDICARE: JOSHUA CHEOL-HONG 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	207R00000X	Internal Medicine Physician	20A8224	CA

General Provider Information

NPI Number	:	1982669552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA CHEOL-HONG KIM D.O.

Provider Business Mailing Address
First Line	:	1011 BALDWIN PARK BLVD
Second Line	:	INTERNAL MEDICINE DEPARTMENT
City	:	BALDWIN PARK
State	:	CA
Zip	:	91706-5806
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	34601 S PHYLLIS ST
Second Line	:
City	:	BLACK CANYON CITY
State	:	AZ
Zip	:	85324-8930
Country	:	US
Telephone Number	:	626-851-5934
Fax Number	:

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

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	11/30/2021

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