Provider Demographics
NPI:1780724435
Name:KIM, MARY I (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:I
Last Name:KIM
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Gender:F
Credentials:MD
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Mailing Address - Street 1:11406 LOMA LINDA DR
Mailing Address - Street 2:SUITE 516
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3711
Mailing Address - Country:US
Mailing Address - Phone:909-558-6277
Mailing Address - Fax:909-558-6278
Practice Address - Street 1:11406 LOMA LINDA DR
Practice Address - Street 2:SUITE 516
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3711
Practice Address - Country:US
Practice Address - Phone:909-558-6277
Practice Address - Fax:909-558-6278
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2014-07-11
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Provider Licenses
StateLicense IDTaxonomies
CA119219208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation