Provider Demographics
NPI:1710921440
Name:KIM, HYUNG OH SR (MD)
Entity Type:Individual
Prefix:
First Name:HYUNG
Middle Name:OH
Last Name:KIM
Suffix:SR
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 1:2621 S BRISTOL ST
Mailing Address - Street 2:SUITE 300-302
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92709
Mailing Address - Country:US
Mailing Address - Phone:714-540-7720
Mailing Address - Fax:714-540-5690
Practice Address - Street 1:2621 S BRISTOL ST
Practice Address - Street 2:SUITE 300-302
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92709
Practice Address - Country:US
Practice Address - Phone:714-540-7720
Practice Address - Fax:714-540-5690
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35664207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A356640OtherMEDICAL PROVIDER NUMBER
B50297Medicare UPIN