Provider Demographics
NPI:1497875363
Name:PAUL E KIM MD INC
Entity Type:Organization
Organization Name:PAUL E KIM MD INC
Other - Org Name:META SPORTS AND PAIN MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:EUIN
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-543-0144
Mailing Address - Street 1:8352 CLAIREMONT MESA BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-1302
Mailing Address - Country:US
Mailing Address - Phone:619-543-0144
Mailing Address - Fax:619-543-0445
Practice Address - Street 1:8352 CLAIREMONT MESA BLVD STE A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1302
Practice Address - Country:US
Practice Address - Phone:619-543-0144
Practice Address - Fax:619-543-0445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63939207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18575AMedicare PIN
CAW18575Medicare PIN
CAH42824Medicare UPIN