Provider Demographics
NPI:1669465225
Name:KIM, JUNGMEE (MD)
Entity type:Individual
Prefix:DR
First Name:JUNGMEE
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15040 IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-1301
Mailing Address - Country:US
Mailing Address - Phone:562-902-1014
Mailing Address - Fax:562-902-1015
Practice Address - Street 1:15040 IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-1301
Practice Address - Country:US
Practice Address - Phone:562-902-1014
Practice Address - Fax:562-902-1015
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA046017207KA0200X, 207K00000X, 207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA953063755OtherTAX ID #
CAG18368Medicare UPIN
CAWA46017AMedicare ID - Type UnspecifiedINDIVIDUAL PROVIDE #
CAW13666Medicare ID - Type UnspecifiedGROUP PROVIDER #