Provider Demographics
NPI:1144225301
Name:KIM, THOMAS C (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:C
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 1:1140 W LA VETA AVE STE 430
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4226
Mailing Address - Country:US
Mailing Address - Phone:714-543-5555
Mailing Address - Fax:714-973-7731
Practice Address - Street 1:1140 W LA VETA AVE STE 430
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4226
Practice Address - Country:US
Practice Address - Phone:714-543-5555
Practice Address - Fax:714-973-7731
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79886174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADB3373OtherRAILROAD MEDICARE
CAW13988OtherMEDICARE PTAN
CAW13988AOtherMEDICARE PTAN
CAHW13988BMedicare PIN
CAG55538Medicare UPIN
CADB3373OtherRAILROAD MEDICARE
CAW13988OtherMEDICARE PTAN
CAHW13988AMedicare PIN