Provider Demographics
NPI:1942432232
Name:KIM, JEONG CHUEL
Entity Type:Individual
Prefix:
First Name:JEONG CHUEL
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1343 W VALENCIA DR
Mailing Address - Street 2:E
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-4044
Mailing Address - Country:US
Mailing Address - Phone:714-525-1035
Mailing Address - Fax:714-525-1046
Practice Address - Street 1:1343 W VALENCIA DR
Practice Address - Street 2:E
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-4044
Practice Address - Country:US
Practice Address - Phone:714-525-1035
Practice Address - Fax:714-525-1046
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2472B0301XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherBiomedical Engineering
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6323130001Medicare NSC