Provider Demographics
NPI:1780690636
Name:KIM, DUKE D (MD)
Entity Type:Individual
Prefix:
First Name:DUKE
Middle Name:D
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 1:26302 LA PAZ RD STE 106
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5327
Mailing Address - Country:US
Mailing Address - Phone:949-328-9972
Mailing Address - Fax:949-328-9976
Practice Address - Street 1:26302 LA PAZ RD
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5313
Practice Address - Country:US
Practice Address - Phone:949-328-9972
Practice Address - Fax:949-328-9976
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24150207KA0200X, 2080A0000X, 2080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA24150AMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
CAA82951Medicare UPIN