Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 50479 | CA |
Y | 213EG0000X | General Practice | 50479 | CA |
NPI | 1003035114 |
---|---|
Provider Name | Dr. Kwang Seob Kim |
First Address | Yorba Linda, CA 92886 |
Second Address | Rowland Heights, CA 91748-2602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 15/03/2019 |