Provider Demographics
NPI:1629265772
Name:KIM, ALYSSA Y (MD)
Entity Type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:Y
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:Y.
Other - Middle Name:ALYSSA
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:14150 CULVER DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-0315
Mailing Address - Country:US
Mailing Address - Phone:714-895-5614
Mailing Address - Fax:949-786-0970
Practice Address - Street 1:14150 CULVER DR
Practice Address - Street 2:SUITE 304
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-0315
Practice Address - Country:US
Practice Address - Phone:949-786-0908
Practice Address - Fax:949-786-0970
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG70663207N00000X, 207ND0101X, 207ND0900X, 207NI0002X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG70663BMedicare PIN