Provider Demographics
NPI:1831309772
Name:KIM JAMES CHARNEY M.D., INC.
Entity type:Organization
Organization Name:KIM JAMES CHARNEY M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CHARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-550-0600
Mailing Address - Street 1:1140 W LA VETA AVE
Mailing Address - Street 2:SUITE 620
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4223
Mailing Address - Country:US
Mailing Address - Phone:714-550-0600
Mailing Address - Fax:714-550-9307
Practice Address - Street 1:1140 W LA VETA AVE
Practice Address - Street 2:SUITE 620
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4223
Practice Address - Country:US
Practice Address - Phone:714-550-0600
Practice Address - Fax:714-550-9307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24258208600000X, 2086S0129X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Not Answered2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Not Answered2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA23878Medicare UPIN