Provider Demographics
NPI:1346282308
Name:MICHAEL K. KIM, M.D., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MICHAEL K. KIM, M.D., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-430-6065
Mailing Address - Street 1:3801 KATELLA AVE
Mailing Address - Street 2:SUITE 414
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3338
Mailing Address - Country:US
Mailing Address - Phone:562-430-6065
Mailing Address - Fax:562-430-6069
Practice Address - Street 1:3801 KATELLA AVE
Practice Address - Street 2:SUITE 414
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3338
Practice Address - Country:US
Practice Address - Phone:562-430-6065
Practice Address - Fax:562-430-6069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86558207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19456Medicare ID - Type Unspecified
CAH29586Medicare UPIN
CAW A86558AMedicare PIN