Provider Demographics
NPI:1801891734
Name:KIM, DONALD D (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:D
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4354 LATHAM ST STE 100
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-1777
Mailing Address - Country:US
Mailing Address - Phone:951-683-0650
Mailing Address - Fax:951-774-4612
Practice Address - Street 1:4354 LATHAM ST STE 100
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-1777
Practice Address - Country:US
Practice Address - Phone:951-683-0650
Practice Address - Fax:951-774-4612
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG58622207X00000X, 207XS0117X, 207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF32539Medicare UPIN
CA00G586220Medicare PIN