Provider Demographics
NPI:1700072550
Name:BANGSUN JUSTIN KIM M.D., INC.
Entity Type:Organization
Organization Name:BANGSUN JUSTIN KIM M.D., INC.
Other - Org Name:KIM MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BANGSUN
Authorized Official - Middle Name:JUSTIN
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-552-8282
Mailing Address - Street 1:2500 ALTON PKWY
Mailing Address - Street 2:SUITE 108
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-5024
Mailing Address - Country:US
Mailing Address - Phone:949-552-8282
Mailing Address - Fax:949-552-2215
Practice Address - Street 1:2500 ALTON PKWY
Practice Address - Street 2:SUITE 108
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-5024
Practice Address - Country:US
Practice Address - Phone:949-552-8282
Practice Address - Fax:949-552-2215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty