Provider Demographics
NPI:1912959669
Name:PAUL S KIM AND KIRK L OHANIAN,MD INC
Entity Type:Organization
Organization Name:PAUL S KIM AND KIRK L OHANIAN,MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:L
Authorized Official - Last Name:OHANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-489-4507
Mailing Address - Street 1:DEPT LA 21586
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91185-0001
Mailing Address - Country:US
Mailing Address - Phone:949-489-4507
Mailing Address - Fax:949-489-4657
Practice Address - Street 1:654 CAMINO DE LOS MARES
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2827
Practice Address - Country:US
Practice Address - Phone:949-489-4507
Practice Address - Fax:949-489-4657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0101710Medicaid
CAZZZ09164ZOtherBLUE SHIELD
CAZZZ65273ZOtherBLUE SHIELD
CAZZZ09164ZOtherBLUE SHIELD
CAZZZ65273ZOtherBLUE SHIELD