Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | G58622 | CA |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | G58622 | CA |
N | 207XS0117X | Orthopaedic Spine Surgeon | G58622 | CA |
NPI | 1801891734 |
---|---|
Provider Name | Donald D Kim |
First Address | Riverside, CA 92501-1777 |
Second Address | Riverside, CA 92501-1777 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 10/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F32539 | (02) | CA |