Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A123721 | CA |
N | 207QS0010X | Family Doctor - Sports Medicine | A123721 | CA |
NPI | 1033404645 |
---|---|
Provider Name | Brian Young Kim |
First Address | Irvine, CA 92697-0001 |
Second Address | Irvine, CA 92697-3414 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2011 |
Last Update Date | 20/10/2021 |