Provider Demographics
NPI:1912295510
Name:KIM, JERRY J (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:J
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:350 VINTON AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-3000
Mailing Address - Country:US
Mailing Address - Phone:909-973-1148
Mailing Address - Fax:909-363-4954
Practice Address - Street 1:350 VINTON AVE STE 202
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3000
Practice Address - Country:US
Practice Address - Phone:909-909-1148
Practice Address - Fax:909-363-4954
Is Sole Proprietor?:No
Enumeration Date:2011-07-16
Last Update Date:2023-08-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA1241302086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery