Provider Demographics
NPI:1619649761
Name:HONG S. KIM MD, INC
Entity Type:Organization
Organization Name:HONG S. KIM MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT /MD
Authorized Official - Prefix:
Authorized Official - First Name:HONG
Authorized Official - Middle Name:S
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-530-3740
Mailing Address - Street 1:12665 GARDEN GROVE BLVD STE 503
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1919
Mailing Address - Country:US
Mailing Address - Phone:714-530-3740
Mailing Address - Fax:714-530-0582
Practice Address - Street 1:12665 GARDEN GROVE BLVD STE 503
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1919
Practice Address - Country:US
Practice Address - Phone:714-530-3740
Practice Address - Fax:714-530-0582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-28
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA45579OtherDR LIC