Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | A046017 | CA |
N | 207KA0200X | Allergist | A046017 | CA |
N | 207RA0201X | Internist - Allergy & Immunology | A046017 | CA |
NPI | 1669465225 |
---|---|
Provider Name | Dr. Jungmee Kim |
First Address | La Mirada, CA 90638-1301 |
Second Address | La Mirada, CA 90638-1301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2005 |
Last Update Date | 07/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
953063755 | TAX ID # (01) | CA |
G18368 | (02) | CA |