Provider Demographics
NPI:1730475732
Name:KIM, ALBERT (DPM)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8283 GROVE AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3139
Mailing Address - Country:US
Mailing Address - Phone:909-500-3007
Mailing Address - Fax:909-530-3007
Practice Address - Street 1:8283 GROVE AVE STE 106
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3139
Practice Address - Country:US
Practice Address - Phone:909-500-3007
Practice Address - Fax:909-530-3007
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE 4938213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery