Provider Demographics
NPI:1780627653
Name:KIM, TAE-SOON (MD)
Entity type:Individual
Prefix:
First Name:TAE-SOON
Middle Name:
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 1:18895 COLIMA RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-2978
Mailing Address - Country:US
Mailing Address - Phone:626-965-5025
Mailing Address - Fax:
Practice Address - Street 1:18895 COLIMA RD
Practice Address - Street 2:SUITE B
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-2978
Practice Address - Country:US
Practice Address - Phone:626-965-5025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32370208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
A26782Medicare UPIN