Provider Demographics
NPI:1619137148
Name:KIM, CHRISTOPHER JINYONG (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JINYONG
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 1:2173 COLLETT AVE
Mailing Address - Street 2:UNIT 213
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-8635
Mailing Address - Country:US
Mailing Address - Phone:925-999-0222
Mailing Address - Fax:
Practice Address - Street 1:10800 MAGNOLIA AVE DEPT OF
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3043
Practice Address - Country:US
Practice Address - Phone:951-235-7251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA117177208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery