Provider Demographics
NPI:1033361720
Name:KIM, CHUNG-LIM (MD)
Entity Type:Individual
Prefix:DR
First Name:CHUNG-LIM
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 AVENIDA CABRILLO
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-4040
Mailing Address - Country:US
Mailing Address - Phone:949-369-6700
Mailing Address - Fax:949-492-4081
Practice Address - Street 1:1900 E LA PALMA AVE STE 101
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-1636
Practice Address - Country:US
Practice Address - Phone:714-399-3480
Practice Address - Fax:714-399-3481
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA455782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry