Provider Demographics
NPI:1629205190
Name:KIM, PAUL J (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
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:FILE 749267
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-9267
Mailing Address - Country:US
Mailing Address - Phone:877-207-9454
Mailing Address - Fax:615-691-7497
Practice Address - Street 1:2895 EDINGER AVE
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7257
Practice Address - Country:US
Practice Address - Phone:949-381-5800
Practice Address - Fax:949-552-5152
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA933982085R0001X
MAL-2391402085R0001X
VA01012470412085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10059062OtherOPTIMA HEALTH
VA1629205190OtherTRICARE
VA401734OtherANTHEM BC/BS (FIRST COLONIAL RD)
VA401742OtherANTHEM BC/BS (GLENN MITCHELL DR.)
VAPAROtherCIGNA
VA401737OtherANTHEM BC/BS (GRESHAM DR.)
NC5914173Medicaid
VAPAROtherMULTIPLAN
VAPAROtherAETNA
VAPAROtherFIRST HEALTH COMMERCIAL/COVENTRY HEALTH/SOUTHERN HEALTH
VAPAROtherUNITED HEALTH CARE/MAMSI
VA1629205190Medicaid
VAPAROtherVA PREMIER HEALTH
VAPAROtherCORVEL/CORCARE
VA401745OtherANTHEM BC/BS (LAKE WRIGHT DR.)
VAPAROtherVA HEALTH NETWORK
VAPAROtherUSA MANAGED CARE
VAVAA101148Medicare PIN