Provider Demographics
NPI:1972079903
Name:KIM MEDICAL CORPORATION
Entity Type:Organization
Organization Name:KIM MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:H
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-447-4100
Mailing Address - Street 1:1950 SUNNY CREST DR STE 2700
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3645
Mailing Address - Country:US
Mailing Address - Phone:714-519-3545
Mailing Address - Fax:714-870-0000
Practice Address - Street 1:1950 SUNNY CREST DR STE 2700
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3645
Practice Address - Country:US
Practice Address - Phone:714-519-3545
Practice Address - Fax:714-870-0000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-17
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty