Provider Demographics
NPI:1831732270
Name:CANDICE KIM INC
Entity type:Organization
Organization Name:CANDICE KIM INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:JINHEE
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-520-5316
Mailing Address - Street 1:25395 HANCOCK AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-9054
Mailing Address - Country:US
Mailing Address - Phone:951-677-6670
Mailing Address - Fax:951-677-6676
Practice Address - Street 1:25395 HANCOCK AVE STE 230
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-9054
Practice Address - Country:US
Practice Address - Phone:951-677-6670
Practice Address - Fax:951-677-6676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-17
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty