Provider Demographics
NPI:1760433296
Name:KIM, PAUL SUNGYUL (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:SUNGYUL
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:PO BOX 14005
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-1405
Mailing Address - Country:US
Mailing Address - Phone:714-571-5000
Mailing Address - Fax:714-571-5055
Practice Address - Street 1:431 S BATAVIA ST
Practice Address - Street 2:STE. 103
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3936
Practice Address - Country:US
Practice Address - Phone:714-538-6731
Practice Address - Fax:714-771-8369
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG770302085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G770300OtherBLUE SHIELD
CA00G770300Medicaid
CA00G770301OtherBLUE SHIELD
CA00G770300159OtherCALOPTIMA
WG77030OMedicare PIN
CAWG77030LMedicare PIN
CA00G770301OtherBLUE SHIELD
CA00G770300159OtherCALOPTIMA
WG77030NMedicare PIN
CAWG77030KMedicare PIN
CAWG77030MMedicare PIN
CA00G770302Medicare PIN
CA00G770300OtherBLUE SHIELD