Provider Demographics
NPI:1609849876
Name:KIM, BRIAN H (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:H
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 W LA VETA AVE STE 430
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4226
Mailing Address - Country:US
Mailing Address - Phone:714-543-5555
Mailing Address - Fax:714-836-2427
Practice Address - Street 1:1140 W LA VETA AVE STE 430
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:714-543-5555
Practice Address - Fax:714-836-2427
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79339207RC0001X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A793390Medicaid
CAP00151896OtherRAILROAD MEDICARE
CA00A793390Medicare PIN
CAP00151896OtherRAILROAD MEDICARE