Provider Demographics
NPI:1275093874
Name:JAMES A. KIM, M.D. A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:JAMES A. KIM, M.D. A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:PAIN AND WELLNESS CENTERS OF SOUTHERN CALIFORNIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-566-8688
Mailing Address - Street 1:361 HOSPITAL RD STE 224
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3523
Mailing Address - Country:US
Mailing Address - Phone:949-566-8688
Mailing Address - Fax:
Practice Address - Street 1:801 N TUSTIN AVE STE 507
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3609
Practice Address - Country:US
Practice Address - Phone:949-566-8688
Practice Address - Fax:949-566-8656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-21
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain