Provider Demographics
NPI:1558326694
Name:KIM, DAE-CHOONG (MD)
Entity Type:Individual
Prefix:DR
First Name:DAE-CHOONG
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8862 GARDEN GROVE BLVD
Mailing Address - Street 2:102
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1262
Mailing Address - Country:US
Mailing Address - Phone:714-539-9963
Mailing Address - Fax:714-539-9752
Practice Address - Street 1:8862 GARDEN GROVE BLVD
Practice Address - Street 2:102
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-1262
Practice Address - Country:US
Practice Address - Phone:714-539-9963
Practice Address - Fax:714-539-9752
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC43192207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C431920Medicaid
CA00C431920Medicaid
CAF19272Medicare UPIN