Provider Demographics
NPI:1275863466
Name:JUNG BONG KIM,MD,INC.
Entity Type:Organization
Organization Name:JUNG BONG KIM,MD,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUNGBONG
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-679-8762
Mailing Address - Street 1:4 LONGBOURN AISLE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-5722
Mailing Address - Country:US
Mailing Address - Phone:949-679-8762
Mailing Address - Fax:949-679-8762
Practice Address - Street 1:4 LONGBOURN AISLE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92603-5722
Practice Address - Country:US
Practice Address - Phone:949-679-8762
Practice Address - Fax:949-679-8762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA100599207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty