Provider Demographics
NPI:1396792677
Name:KIM, HYONG J (MD)
Entity type:Individual
Prefix:
First Name:HYONG
Middle Name:J
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 1:12900 PARK PLAZA DR STE 150
Mailing Address - Street 2:ATTENTION: MAGGIE NOLES MS 6165
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-9329
Mailing Address - Country:US
Mailing Address - Phone:562-741-4461
Mailing Address - Fax:562-622-2971
Practice Address - Street 1:10000 LAKEWOOD BLVD
Practice Address - Street 2:ATTENTION MAGGIE NOLES MS 6165
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-4020
Practice Address - Country:US
Practice Address - Phone:562-862-3684
Practice Address - Fax:562-862-7145
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63995207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
075479OtherHEALTH NET ID #
00A639950OtherBLUE SHIELD ID #
110190205OtherRAILROAD
CA00A639950Medicaid
CAWA63995CMedicare PIN
00A639950OtherBLUE SHIELD ID #
CAWA63995AMedicare PIN
CAWA63995BMedicare PIN