Provider Demographics
NPI:1376554956
Name:KIM, GEMMA (MD)
Entity Type:Individual
Prefix:
First Name:GEMMA
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GEMMA
Other - Middle Name:
Other - Last Name:JUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:555 E TACHEVAH DR
Mailing Address - Street 2:SUITE 2E #107
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-5750
Mailing Address - Country:US
Mailing Address - Phone:760-561-7373
Mailing Address - Fax:760-327-5140
Practice Address - Street 1:555 E TACHEVAH DR STE 3W105
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-5747
Practice Address - Country:US
Practice Address - Phone:760-318-4730
Practice Address - Fax:760-416-7639
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC55682207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine