Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | A64323 | CA |
Y | 207XS0117X | Orthopaedic Spine Surgeon | A64323 | CA |
NPI | 1124043765 |
---|---|
Provider Name | Dr. Choll Wan Kim |
First Address | San Diego, CA 92120-5270 |
Second Address | San Diego, CA 92120-5270 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 31/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A643230 | (05) | CA |
H36132 | (02) | CA |