Provider Demographics
NPI:1689334476
Name:JONGJIN KIM MD INC
Entity Type:Organization
Organization Name:JONGJIN KIM MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONGJIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-752-6088
Mailing Address - Street 1:5471 LA PALMA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-4702
Mailing Address - Country:US
Mailing Address - Phone:714-752-6088
Mailing Address - Fax:657-577-9135
Practice Address - Street 1:5471 LA PALMA AVE STE 200
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-4702
Practice Address - Country:US
Practice Address - Phone:714-752-6088
Practice Address - Fax:657-577-9135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty