Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | A46079 | CA |
N | 207R00000X | Internist | A46079 | CA |
N | 111NI0900X | Internist | A46079 | CA |
NPI | 1477564607 |
---|---|
Provider Name | Dr. Chin Se Kim |
First Address | Anaheim, CA 92801-1854 |
Second Address | Anaheim, CA 92801-1854 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 05/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A46079 | (05) | CA |
E48498 | (02) | CA |