Provider Demographics
NPI:1598032559
Name:KIM, JOHN HAKKYUN (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HAKKYUN
Last Name:KIM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:197 ROBINSON DR
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-1099
Mailing Address - Country:US
Mailing Address - Phone:909-519-6426
Mailing Address - Fax:
Practice Address - Street 1:3195 HARBOR BLVD STE 3
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-2514
Practice Address - Country:US
Practice Address - Phone:714-263-0227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-18
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-PHYS-LIC-44468207Q00000X
NVDO2053207Q00000X
WY10498A207Q00000X
IDO-0956207Q00000X
CODR.0057596207Q00000X
AZ006843207Q00000X
NMA-2009-16207Q00000X
ORDO175031207Q00000X
WAOP60610276207Q00000X
AK114581207Q00000X
HIDOS-1793207Q00000X
CA20A11648207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine