Provider Demographics
NPI:1114007697
Name:JANET B. KIM, M.D., INC.
Entity Type:Organization
Organization Name:JANET B. KIM, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:BONNIE
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-328-9972
Mailing Address - Street 1:26302 LA PAZ RD #106
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5380
Mailing Address - Country:US
Mailing Address - Phone:949-328-9972
Mailing Address - Fax:949-328-9976
Practice Address - Street 1:26302 LA PAZ RD #106
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5380
Practice Address - Country:US
Practice Address - Phone:949-328-9972
Practice Address - Fax:949-328-9976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18435Medicare ID - Type Unspecified