Provider Demographics
NPI:1972792273
Name:KIM, GWANG MOO (MD)
Entity Type:Individual
Prefix:DR
First Name:GWANG
Middle Name:MOO
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4482 BARRANCA PKWY
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-7701
Mailing Address - Country:US
Mailing Address - Phone:213-700-7151
Mailing Address - Fax:213-700-7151
Practice Address - Street 1:695 S HARVARD BLVD FL 1
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-2501
Practice Address - Country:US
Practice Address - Phone:213-388-9988
Practice Address - Fax:213-739-1500
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2009-05-14
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Provider Licenses
StateLicense IDTaxonomies
CAA41115207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine