Provider Demographics
NPI:1235593427
Name:KIM, THOMAS (DO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:863 TERRACE LN W UNIT 6
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-4562
Mailing Address - Country:US
Mailing Address - Phone:626-808-3121
Mailing Address - Fax:
Practice Address - Street 1:2520 CHERRY AVE STE 288
Practice Address - Street 2:
Practice Address - City:SIGNAL HILL
Practice Address - State:CA
Practice Address - Zip Code:90755-2032
Practice Address - Country:US
Practice Address - Phone:909-345-0340
Practice Address - Fax:909-760-3459
Is Sole Proprietor?:No
Enumeration Date:2016-04-13
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16264208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation