Provider Demographics
NPI:1740200476
Name:KIM, JOO R (MD)
Entity Type:Individual
Prefix:DR
First Name:JOO
Middle Name:R
Last Name:KIM
Suffix:
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 1:9905 BACE AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93307-6211
Mailing Address - Country:US
Mailing Address - Phone:661-831-1100
Mailing Address - Fax:661-831-8279
Practice Address - Street 1:9905 BACE AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93307-6211
Practice Address - Country:US
Practice Address - Phone:661-831-1100
Practice Address - Fax:661-831-8279
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA28531173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A380850Medicaid
CAA28531Medicare UPIN
CA00A380850Medicare ID - Type Unspecified