Provider Demographics
NPI:1639887417
Name:KIM, JORGE A
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:A
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 ROCKING RM LN
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-2823
Mailing Address - Country:US
Mailing Address - Phone:909-706-9918
Mailing Address - Fax:
Practice Address - Street 1:3240 ROCKING RM LN
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-2823
Practice Address - Country:US
Practice Address - Phone:909-706-9918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst