Provider Demographics
NPI:1609885581
Name:KIM, HYUNG S (MD)
Entity Type:Individual
Prefix:
First Name:HYUNG
Middle Name:S
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 28015
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92809-0133
Mailing Address - Country:US
Mailing Address - Phone:714-777-2469
Mailing Address - Fax:714-777-2469
Practice Address - Street 1:26357 MCBEAN PKWY STE 210
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91355-4497
Practice Address - Country:US
Practice Address - Phone:661-593-7379
Practice Address - Fax:661-568-6856
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA814972081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABO920ZMedicare PIN
CAI33325Medicare UPIN
CAWA81497AMedicare PIN