Provider Demographics
NPI:1952763054
Name:KIM, KAIDI HE (MD)
Entity Type:Individual
Prefix:DR
First Name:KAIDI
Middle Name:HE
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KAIDI
Other - Middle Name:
Other - Last Name:HE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12751 HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-5800
Mailing Address - Country:US
Mailing Address - Phone:888-499-9303
Mailing Address - Fax:323-201-3207
Practice Address - Street 1:12751 HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-5800
Practice Address - Country:US
Practice Address - Phone:888-499-9303
Practice Address - Fax:323-201-3207
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA154409208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics