Provider Demographics
NPI:1003886698
Name:KIM, STEVEN WOONG (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:WOONG
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 N HARBOR BLVD STE 3200
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3826
Mailing Address - Country:US
Mailing Address - Phone:714-446-5900
Mailing Address - Fax:714-446-5800
Practice Address - Street 1:2151 N HARBOR BLVD STE 3200
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3826
Practice Address - Country:US
Practice Address - Phone:714-446-5900
Practice Address - Fax:714-446-5800
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000491207RH0003X
CAC52751207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006018491Medicaid
NC89126K7Medicaid
NCH14617Medicare UPIN
VA007105P39Medicare ID - Type Unspecified
NC2017088Medicare ID - Type Unspecified
CADR925ZMedicare PIN